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Updated: Aug 8, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Characteristics of Radial Artery Coronary Bypass Graft Failure and Outcomes Following Subsequent Percutaneous
Garry W Hamilton1, Diem Dinh2, Julian Yeoh3
1Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia. Electronic address: https://twitter.com/GarryHamilton6.
Insights
Percutaneous coronary intervention (PCI) in radial artery (RA) grafts is feasible and safe, showing similar 3-year mortality compared to native vessel or saphenous vein graft (SVG) PCI. This offers a viable alternative for arterial graft stenosis treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Percutaneous coronary intervention (PCI) is a common treatment for coronary artery disease.
- Coronary artery bypass grafting (CABG) is often performed when PCI is not feasible.
- Saphenous vein grafts (SVGs) are frequently used in CABG, but arterial grafts like the radial artery (RA) are also utilized.
Purpose of the Study:
- To characterize arterial graft stenoses.
- To evaluate the feasibility and safety of RA PCI.
- To compare outcomes of RA PCI with native vessel PCI and SVG PCI.
Main Methods:
- Retrospective analysis of 2,780 patients undergoing PCI after CABG from 2005-2018.
- Data stratified by PCI target: native vessel, SVG, RA, or internal mammary artery graft.
- Primary outcome: 3-year mortality. Secondary outcomes: periprocedural and 30-day outcomes.
Main Results:
- RA PCI was performed in 86 patients (3.1%).
- RA PCI patients had different baseline characteristics and lesion locations compared to SVG PCI.
- RA PCI showed no significant difference in periprocedural outcomes, 30-day outcomes, or 3-year mortality compared to native or SVG PCI.
Conclusions:
- Arterial graft stenoses have different characteristics than SVG stenoses.
- RA PCI is feasible, safe, and a viable alternative to native PCI when anatomically suitable.
- Further research may explore long-term outcomes and optimal patient selection for RA PCI.
Background:
When patients with prior coronary artery bypass grafting (CABG) undergo percutaneous coronary intervention (PCI), targeting the native vessel is preferred. Studies informing such recommendations are based predominantly on saphenous vein graft (SVG) PCI. There are few data regarding arterial graft intervention, particularly to a radial artery (RA) graft.
Objectives:
The aim of this study was to report the characteristics of arterial graft stenoses and evaluate the feasibility of RA PCI.
Methods:
This study included 2,780 consecutive patients with prior CABG undergoing PCI between 2005 and 2018 who were prospectively enrolled in the MIG (Melbourne Interventional Group) registry. Data were stratified by PCI target vessel. RA graft PCI was compared with both native vessel (native PCI) and SVG PCI. Internal mammary graft PCI data were reported. The primary outcome was 3-year mortality.
Results:
Overall, 1,928 patients (69.4%) underwent native PCI, 716 (25.6%) SVG PCI, 86 (3.1%) RA PCI, and 50 (1.8%) internal mammary graft PCI. Compared with SVG PCI, the RA PCI cohort presented earlier after CABG, less frequently had acute coronary syndrome, and more commonly had ostial or distal anastomosis intervention (P < 0.005 for all). Compared with patients who underwent native PCI, those who underwent RA PCI were more likely to have diabetes and peripheral vascular disease (P < 0.001 for both) and to present with non-ST-segment elevation myocardial infarction (P = 0.010). The RA PCI group had no perforations or in-hospital myocardial infarctions, though no significant difference was found in periprocedural outcomes compared with either native or SVG PCI. No differences were found between RA PCI and either native or SVG PCI in 30-day outcomes or 3-year mortality.
Conclusions:
Presenting and lesion characteristics differed between patients undergoing arterial compared with SVG PCI, implying a varied pathogenesis of graft stenosis. RA PCI appears feasible, safe, and where anatomically suitable, may be a viable alternative to native PCI.
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