A 65-year-old female presents with acute dyspnea, pleuritic chest pain, and syncope. CT pulmonary angiography confirms a massive pulmonary embolism. She has a history of an intracerebral hemorrhage three months ago. Her current blood pressure is 80/50 mmHg. What is the most appropriate immediate management?

✓ Correct Answer: Option B

For a massive pulmonary embolism with hemodynamic instability, a recent intracranial hemorrhage is a strong contraindication to systemic thrombolysis. In such cases, surgical embolectomy or catheter-directed interventions are preferred to rapidly reduce clot burden and improve hemodynamics.