Hyperoxemic Reperfusion Therapy

This policy addresses hyperoxemic reperfusion therapy (supersaturated/aqueous oxygen intracoronary infusion, e.g., SSO2/TherOx) as an adjunct to percutaneous coronary intervention (PCI) with stenting to reduce infarct size in patients with acute anterior (LAD) ST‑elevation myocardial infarction. Use is described for immediate post‑PCI delivery (typically a 60–90 minute intracoronary infusion) in patients with LAD infarcts treated within about 6 hours of symptom onset, but the therapy is considered experimental/investigational and unproven (policy inactive), supported only by small/single‑arm studies, with FDA approval specific to the TherOx Downstream® System and not evaluated for non‑LAD infarcts or cardiogenic shock.

"SuperSaturated Oxygen (SSO2) therapy following PCI with stenting for anterior AMI caused by a left anterior descending (LAD) artery infarct lesion."