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Radial Artery Graft Superiority — EECC MCQ

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ModerateCoronary Artery DiseaseRadial Artery Graft SuperiorityEECC

A 62-year-old man with three-vessel disease and diabetes undergoes CABG with LIMA-LAD and bilateral radial artery grafts to the OM1 and RCA. Why is the radial artery increasingly favoured over saphenous vein grafts?

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Correct answer: B — The radial artery has superior long-term patency compared with SVG (~90% vs ~60% at 10 years) due to its arterial wall structure resisting atherosclerosis; the RADIAL trial and meta-analyses showed reduced cardiac events with radial artery versus SVG grafting

Radial artery grafts have emerged as a superior conduit to SVG based on the RADIAL trial (5-year) and RAPCO trial (10-year), which showed: (1) higher 10-year patency (~90% vs ~60% for SVG); (2) reduced composite of death, MI, or repeat revascularisation with radial vs SVG. The radial artery's muscular wall resists atherosclerotic degeneration (unlike vein grafts which develop accelerated atherosclerosis from arterialization). The 2024 ESC CCS Guidelines recommend: LIMA-LAD (Class I — the strongest evidence for any graft), second arterial graft (radial artery or RIMA) to the second most important target vessel (Class IIa), with SVG for remaining targets. Pre-operative Allen test (or pulse oximetry with radial compression) confirms adequate ulnar collateral supply before radial harvest. CCB/nitrate therapy post-operatively prevents radial artery spasm.

Reference: ESC (2024): CCS Guidelines; RADIAL Trial