Remarks: Catheter-assisted thrombus removal refers to mechanical interventions, with or without catheter directed thrombolysis. Pulmonary Thromboendarterectomy in for the Treatment of Chronic Thromboembolic Pulmonary Hypertension Summary of the Evidence The AT9 recommendation was based on case series that have shown marked improvements in cardiopulmonary status after thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension Although additional case series have been reported, the quality of the evidence for thromboendarterectomy in patients with CTEPH has The AT10 panel decided, however, that our previous recommendation for thromboendarterectomy in selected patients with CTEPH was too restrictive and could contribute to suboptimal evaluation and treatment of patients with CTEPH. For example, because of improvements in surgical technique, it is now often possible to remove organized thrombi from peripheral pulmonary arteries. In patients with inoperable CTEPH or persistent pulmonary hypertension after pulmonary thromboendarterectomy, there is new evidence from a randomized trial that pulmonary vasodilator therapy may be of bene t.163 For these reasons, we no longer identify central disease as a selection factor for thromboendarterectomy in patients with CTEPH, and we emphasize that patients with CTEPH should be assessed by a team with expertise in the evaluation and management of pulmonary hypertension.153,159,164-166 *26. In selected patients with chronic thromboem- bolic pulmonary hypertension (CTEPH) who are identi ed by an experienced thromboendarter- ectomy team, we suggest pulmonary thromboen- darterectomy over no pulmonary thromboendarterectomy (Grade 2C). Remarks: Patients with CTEPH should be evaluated by a team with expertise in treatment of pulmonary hypertension. Pulmonary thromboendarterectomy is often lifesaving and life-transforming. Patients with CTEPH who are not candidates for pulmonary thromboendarterectomy may bene t from other mechanical and pharmacological interventions designed to lower pulmonary arterial pressure. 