Verapamil and Nitroglycerin Improves the Patency Rate of Radial Artery Grafts

Abstract

The best way to prevent spasm of the radial artery is still under investigation. We retrospectively compared the effectiveness of topical verapamil-nitroglycerin with papaverine in preventing graft spasm in 215 patients who underwent isolated conventional coronary artery bypass using a radial artery. Postoperative angiographic data were successfully collected in 116 patients. Perioperative radial artery graft spasm was observed in 2 patients in the papaverine group and 1 in the verapamil-nitroglycerin group; this difference was not considered significant. Complete or functional occlusion was detected by postoperative angiography in 13 grafts (10 in the papaverine group and 3 in the verapamil-nitroglycerin group). Multivariate regression analysis revealed that topical papaverine and grafting to the right coronary artery significantly increased the rate of occlusion of radial artery grafts. Although further studies are needed, our data support the view that topical verapamil-nitroglycerin reduces the incidence of radial artery graft occlusion.

Radial artery as graft for coronary artery bypass surgery: Advantages and disadvantages for its usage focused on structural and biological characteristics

“…In a study by Yoshizaki et al [115] including 215 patients, topical use of VG solution led to better patency of RA grafts than papaverine, which was confirmed by angiography more than a year after the operation. Moreover, although papaverine causes vasorelaxation through multiple mechanisms: phosphodiesterase inhibition, decreased calcium influx, and inhibition of the release of intracellularly stored calcium [129], it is very acid, resulting in damaged endothelium [130][131][132].…”

“…Reversible spasm is more frequent than is believed and unstable hemodynamics can declare spasm only in grafts supplying with blood critical coronary territories [115]. Moreover, the mechanism of severe spasm in the RA appears to be more difficult to reverse compared with the LITA [116].…”

Mechanisms, Consequences, and Prevention of Coronary Graft Failure

“…Yoshizaki and coworkers reviewed angiographic results among 116 CABG patients who had RA grafts and were treated either with verapamil-nitroglycerin or papaverine. 53 Results showed that papaverine was significantly associated with RA graft occlusion. Among patients randomized to either continue or suspend diltiazem therapy 1 year after RA grafting, Gaudino and colleagues showed that at 5-year follow-up there was no difference in angiographic patency rates between groups.…”

Combined effect of left stellate ganglion blockade and topical administration of papaverine on left internal thoracic artery blood flow in patients undergoing coronary revascularization

“…[ 4 15 ] Some of the drug combinations such as intraluminal or topical administration of calcium antagonists or milrinone with NTG have demonstrated synergistic effects on vasodilation. [ 15 16 ] Papaverine produces vascular relaxation through several mechanisms, including inhibition of phosphodiesterase and release of intracellularly stored calcium resulting in decreased calcium influx. [ 17 ] Intraluminal and periarterial injections have been shown to induce more vasodilatation than the topical application of papaverine.…”