Background: The optimal use of pharmaco-mechanical therapy is not clear in the management of the acute massive pulmonary thromboembolism. Methods: A 30-year-old postpartum female presented with acute massive pulmonary embolism and was managed with catheter mediated thrombus aspiration and fragmentation after the standard intravenous thrombolysis had failed. Thrombus was aspirated by 7F Mullins sheath with 50cc aspiration syringe and was fragmented by TYSHAK II PTV balloon. This was followed by catheter directed thrombolysis. Results: Intravenous thrombolysis was only partially successful whereas catheter mediated thrombus aspiration and fragmentation followed by catheter directed thrombolysis resulted in hemodynamic stabilization and early discharge from the hospital. Conclusion: Pharmaco-mechanical therapy is an effective therapy of acute massive pulmonary embolism and may be beneficial over the standard systemic thrombolysis.