Objective To evaluate the feasibility and early outcomes of large-bore mechanical thrombectomy for intermediate-high and high-risk pulmonary embolism (PE) in a regional Australian tertiary referral centre. Methods A retrospective cohort study was conducted at a regional tertiary hospital in North Queensland between January 2022 and June 2025. Consecutive patients undergoing mechanical thrombectomy following multidisciplinary Pulmonary Embolism Response Team (PERT) evaluation were included. Demographic, procedural, and short-term clinical outcomes were analysed descriptively. Results Twenty-three patients underwent mechanical thrombectomy. Technical success was achieved in all cases (100%) with no immediate procedural complications. Eleven patients (47.8%) required post-procedural intensive care unit admission. Mean oxygenation saturation increased modestly following intervention (94.7% to 96.4%), although interpretation is limited by heterogeneity in oxygen support. Among 17 patients with follow-up imaging within 48 hours, 6 (35.3%) demonstrated reduction in right ventricular to left ventricular (RV/LV) ratio to < 0.9. The mean hospital length of stay was 17.9 ± 21.6 days (median 9 days). Thirty-day mortality was 8.7%. Conclusions Large-bore mechanical thrombectomy for acute PE was feasible and safely delivered in a regional Australian centre, with acceptable short-term outcomes in a high-risk cohort. These findings support the potential for appropriately resourced regional centres to provide advanced interventional PE care.