Abstract Body: Background: Epicardial reperfusion after PCI in anterior MI may not prevent microvascular obstruction and reperfusion injury. Intracoronary supersaturated oxygen (SSO2) delivers hyperoxemic blood after reperfusion and may support microvascular recovery.
Hypothesis: Adjunctive intracoronary SSO2 after IVUS-guided LAD PCI is feasible and associated with robust reperfusion signals without excess short-term adverse events.

Methods: We retrospectively reviewed three consecutive patients with thrombotic LAD culprit lesions who underwent aspiration thrombectomy and IVUS-guided PCI with 1–2 drug-eluting stents, followed by a 60-minute post-PCI intracoronary SSO2 infusion into the left coronary system/LAD per institutional protocol. Baseline and 3-month transthoracic echocardiograms were compared. Angiographic reperfusion and ST-segment resolution were assessed; in-hospital and 30-day safety events were abstracted.

Results: SSO2 was successfully delivered in all patients without reported device-related complications. Baseline angiographic flow was TIMI 0–1 and improved to TIMI 3 after PCI in all cases. Complete ST-segment resolution (>70%) at 60 minutes post-PCI was observed in all patients. Baseline EF was 35–40% with anterior/anteroseptal and apical dysfunction in all cases. At 3 months, EF improved to 45–50%, 50–55%, and 45–50%, with qualitative improvement in anterior/apical wall motion. No VT/VF, major bleeding, stroke, AKI, access-site complication, death, reinfarction, or heart failure admission occurred during hospitalization or within 30 days.

Conclusions: In this small real-world series of thrombotic anterior MI treated with IVUS-guided LAD PCI, adjunctive intracoronary SSO2 therapy was feasible, achieved strong reperfusion signals (TIMI 3 flow and >70% ST-segment resolution), and had an acceptable short-term safety profile with consistent LV functional recovery at follow-up. Larger studies are needed to define impact on infarct size, microvascular obstruction, and clinical outcomes.