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Myocardial revascularization with the radial artery: a clinical and angiographic study
F D da Costa1, I A da Costa, R Poffo
1Department of Cardiac Surgery of the Santa Casa, Pontifícia Universidade Católica do Paraná, Curitiba, Brasil.
Insights
Radial artery grafts show promise for coronary artery bypass grafting, with high early patency rates. Further studies are needed to confirm long-term efficacy in myocardial revascularization procedures.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Interventional Cardiology
Background:
- Internal thoracic artery grafts offer superior long-term patency compared to saphenous vein grafts in coronary artery bypass grafting.
- This has led to increased interest in alternative arterial conduits, such as the radial artery.
Purpose of the Study:
- To evaluate the early and mid-term efficacy and safety of using radial artery grafts for myocardial revascularization.
Main Methods:
- A cohort of 83 patients underwent myocardial revascularization using radial artery grafts between April 1994 and January 1996.
- Patients received diltiazem for vasospasm prevention.
- Early postoperative angiography was performed in 61 patients, with a subset undergoing follow-up angiography at a mean of 8.7 months.
Main Results:
- Four hospital deaths (4.8%) occurred, none cardiac-related. One graft occlusion and two instances of graft spasm were noted among 61 early angiograms (96.7% patency).
- All 12 grafts assessed in the mid-term follow-up remained patent.
- One patient with early graft spasm developed recurrent symptoms and graft narrowing (string sign) on repeat angiography.
Conclusions:
- The radial artery appears to be a viable option for coronary artery bypass grafting, demonstrating good early patency when managed appropriately.
- Long-term follow-up and continued angiographic studies are essential to fully establish the radial artery's role in coronary revascularization.
Background:
It has been well documented that the use of the internal thoracic artery yields better long-term patency rates than saphenous vein grafts for coronary artery bypass grafting. This knowledge has prompted surgeons to use other arterial conduits such as the radial artery.
Methods:
Between April 1994 and January 1996, radial artery grafts were used in 83 patients (mean age, 54.6 years) undergoing myocardial revascularization. All patients received diltiazem, 80 mg orally three times daily. Angiographic studies were performed in the early post-operative period in 61 patients, and 6 to 19 months later in 12 patients.
Results:
There were four hospital deaths (4.8%), none of them due to cardiac causes. Perioperative myocardial infarction was observed in 3 patients, 1 related to a radial artery graft occlusion. Of 61 grafts studied early, 59 were patent (96.7%), but two grafts showed diffuse spasm. Twelve patients had a second angiogram after a mean interval of 8.7 months, and all grafts were patent. One patient who had a diffuse spasm at the early study had recurrent symptoms, and repeat angiogram showed further narrowing of the graft (string sign).
Conclusions:
Our results suggest that with proper care, the radial artery may be used for coronary artery bypass grafting with good early results. Long-term follow-up and angiography studies will be needed to establish the merit of the radial artery as a graft for coronary artery operations.