Background and Aims All the current treatment strategies for high-risk acute pulmonary embolism (PE) patients will increase the risk of serious bleeding events that include the intracranial bleeding. AngioJet rheolytic thrombectomy (ART) enables a high-pressure pulse injection of thrombolytic agents to break down and dissolve the blood clots, and meanwhile allows aspiration in the pulmonary artery branches at the segmental level, which is theoretically an effective approach for acute PE. However, its safety needs to be further assessed. This study was conducted to analyzed the safety and efficacy of ART for the treatment of acute PE by reviewing the data of 3 patients with acute PE treated with ART.Methods The clinical data of three patients with acute PE treated by ART in the Center of Vascular Surgery of Beijing Anzhen Hospital, Capital Medical University from June 2021 to September 2021 were reviewed. The safety and effectiveness of ART treatment were evaluated by comparing the changes in vital signs and PE-related data of the patients.Results The technical success rate of ART was 100%. After ART, systolic pulmonary artery pressure, systolic displacement of the tricuspid ring, right ventricular diameter/left ventricular diameter ratio, blood oxygen saturation and B-type natriuretic peptide level were significantly improved in all patients. Transient bradycardia occurred in all the 3 patients, which was relieved after symptomatic treatment. No serious complications associated with surgery occurred in all patients during perioperative period. One patient died due to coronary heart disease, infectious-toxic shock, and ischemic hypoxic encephalopathy at 36 d after operation. The other two patients were followed-up for 3 months, and the pulmonary arterial pressure and right heart function of them were significantly recovered.Conclusion ART is a safe and effective method for patients with intermediate high-risk and high-risk acute PE. For reducing the ART-related complications, manipulation should be gentle, aspiration time should be strictly controlled, and close attention should be paid to the changes in blood pressure and heart rate of patients during the operation, and supplementation of low dose thrombolytic agent should be considered after ART if necessary. Meanwhile, adequate perioperative hydration and reduced use of the contrast agent can decrease the renal burden, so as to avoid the occurrence of acute renal insufficiency.