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    PE Reperfusion / IR Consult Triage

    PERC rule and Wells score calculator, plus an educational tool to support monitoring vs escalation decisions and when to involve Pulmonary/PERT and IR.

    Not medical advice. Use local PE/PERT protocols and clinical judgment. Do not enter patient identifiers or free-text case details. This tool does not store or transmit data.

    PERC rule and Wells score calculator for pulmonary embolism

    Use these before imaging. The PERC rule applies only when your gestalt pretest probability is low (under about 15%); if all eight criteria are absent, PE can be ruled out without a D-dimer. The Wells score stratifies pretest probability. The reperfusion triage below is for PE that is already confirmed.

    PERC rule (Pulmonary Embolism Rule-out Criteria)

    PERC negative — 0 of 8 criteria present. In a low-pretest-probability patient, PE is effectively excluded (miss rate under 2%) and no D-dimer is needed.

    Wells score for PE

    Wells score 0 — PE unlikely (two-tier) · low probability (three-tier). Consider PERC, then D-dimer if PERC positive.

    Two-tier Wells: 4 or less = PE unlikely, more than 4 = PE likely. Three-tier: under 2 low, 2 to 6 moderate, over 6 high. Educational reference; follow local protocols.

    1 Context
    2 Hemodynamics
    3 RV
    4 Biomarkers
    5 Trajectory
    6 Modifiers

    1 Context

    Stability window used by this tool: last 4–6 hours (ED).

    Step 1 of 6

    2 Hemodynamics / Instability Screen

    Step 2 of 6

    3 RV Dysfunction

    Step 3 of 6

    4 Biomarkers

    Same units for both. Example: hs-TnT upper limit 14 ng/L, so 15–42 is mild and over 42 is marked.

    pg/mL and ng/L are the same number for these tests.

    Step 4 of 6

    5 Trajectory / Objective Deterioration

    Objective deterioration within the stability window (ED: 4–6h).

    Do not use this if escalation occurred due to bed availability.

    Step 5 of 6

    6 Timing / Anatomy / Safety Modifiers

    Step 6 of 6
    • STORM-PE (RCT, 2024): In intermediate-high risk PE, computer-assisted vacuum thrombectomy + anticoagulation improved 48-hour RV/LV reduction vs anticoagulation alone and normalized vital signs earlier; no demonstrated mortality benefit; procedure risks exist.
    • PEERLESS (RCT, 2024): In patients selected for catheter intervention, large-bore mechanical thrombectomy outperformed catheter-directed thrombolysis on a composite driven by less deterioration/bailout and less ICU utilization/shorter LOS; no difference in mortality or major bleeding.
    • Guideline framing (ESC/ACC summaries): Systemic thrombolysis is reserved for high-risk hemodynamic instability; routine reperfusion is not recommended for stable intermediate-risk PE; catheter-based or surgical options are generally considered for rescue when instability develops or when thrombolysis is contraindicated/failed.
    • Access-site bleeding/hematoma; vascular injury
    • Pulmonary artery injury/rupture (rare, serious)
    • Cardiac irritation/arrhythmias; heart block (device-dependent)
    • Hemolysis and possible renal stress (device-dependent)
    • Limited reach for distal clot; residual segmental disease may persist
    • Potential embolization/clot migration

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    Written and reviewed by Pouyan Golshani, MD, Interventional Radiologist — Last updated April 7, 2026

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