Effect of target stenosis and location on radial artery graft patency

Abstract

Radial artery patency is sensitive to both target location and proximal target stenosis. Selective use of the radial artery to targets of the left anterior descending and circumflex distributions remains encouraging. Radial artery grafts to targets of the right coronary artery or those with moderate stenosis appear to be at particularly high risk of failure.

Radial Artery Bypass Grafts Have an Increased Occurrence of Angiographically Severe Stenosis and Occlusion Compared With Left Internal Mammary Arteries and Saphenous Vein Grafts

“…Multiple studies have replicated these findings, which indicates that early angiographic patency with radial artery grafts in the modern era consistently exceeds 90% and is similar to results achieved with the IMA. [7][8][9][10][11][12][13] In addition to these reports, the increasing acceptance of the radial artery has been based on 2 studies with angiographic results, both with 5 years of follow-up. In one, angiography in 50 patients with 64 radial grafts revealed a patency rate of 83%.…”

“…In addition, a recent larger study of 109 patients who underwent cardiac catheterization for symptoms of ischemia showed an overall patency rate of the radial artery graft of only 75.1% at a mean follow-up of 2.3 years. 13 Improvements in harvesting techniques and postoperative administration of calcium channel blockers were expected to lead to improved results with the radial artery, yet we are concerned that these technical advances and pharmacological therapies have merely delayed the ultimate poor outcome with these grafts. The exact mechanism for the observed high rate of radial artery graft failure is not known.…”

“…11 In situations in which this does not occur (less than critical native coronary stenosis or right coronary artery), the radial artery may be more prone to graft occlusion. 13,15,20 The present study does support this mechanism in part, because the patency rate was much lower with anastomoses to non-left anterior descending artery Variables analyzed included type of graft (LIMA, RIMA, SVG, and radial artery) for the entire cohort only and time since CABG, graft target vessel (left anterior descending artery, left circumflex, or right coronary artery), redo CABG, smoking, diabetes mellitus, hypertension, hyperlipidemia, age, and gender for both the entire cohort and the radial artery cohort alone.…”

“…The radial artery also should bypass critically narrowed arteries, according to data from other institutions. 13,15,20 The ideal of total arterial revascularization has been based on the presumption that all arterial grafts are associated with superior long-term patency compared with the SVG. The present data indicate that in patients predominantly presenting with recurrent signs or symptoms of myocardial ischemia, the radial artery is associated with a high rate of severe stenosis and occlusion.…”

“…7 Multiple institutions have documented that the radial artery can be used with acceptable morbidity and mortality 8 -10 and that early angiographic results in the modern era approach those of the IMA. [7][8][9][10][11][12][13] This has led to a dramatic increase in the number of patients receiving radial artery bypass grafts. Yet, there are limited data on the later angiographic outcomes of these grafts.…”