Objective: To investigate the safety and efficacy of catheter crushing/aspiration thrombus combined with local thrombolytic therapy for acute pulmonary thromboembolism (APTE) based on pulmonary artery computed tomography obstruction index (CTI%). Methods: The clinical and imaging data of APTE patients who received catheter crushing/aspiration thrombus combined with local thrombolytic therapy from January 2011 to March 2022 were analyzed and graded by CTI%. Results: Fifty patients, including mild (n=11, 20.0%), moderate (n=17, 34.0%) and severe (n=22, 44.0%) APTE by CTI%, were included. The grading based on CTI% had no obvious correlation with simplified pulmonary embolism severity index (sPESI) (P=0.225). There were significant differences in preoperative blood oxygen saturation and D-dimer levels among the three groups (P< 0.05). Among the 50 patients, 12 cases (24.0%) were treated by catheter crushing thrombus combined with local thrombolysis, 37 cases (74.0%) by catheter aspiration thrombus combined with local thrombolysis, and 1 case (2.0%) by catheter crushing thrombus/aspiration thrombus combined with local thrombolysis. The technic success rate was 100% and clinical success rate was 88.0% (44/50). The perioperative mortality was 12.0% (6/50, 1 case in moderate APTE, 5 cases in severe APTE). Of the 44 patients, 36 cases were followed up regularly. With mean 34.6±33.1 months follow-up and there were no APTE recurrence and anticoagulation related complications. Pulmonary hypertension occurred in 5 patients (13.9%, 2 cases in moderate APTE, 3 cases in severe APTE) and ten patients (27.8%, 3 cases in mild APTE, 4 cases in moderate APTE, 3 cases in severe APTE) had left ventricular diastolic dysfunction. Conclusions: Catheter crushing/aspiration thrombus combined with local thrombolytic therapy is safe and effective in the treatment of APTE. Patients with moderate to severe APTE by CTI% have high perioperative mortality and high risk of pulmonary hypertension and cardiac insufficiency.