Radial artery graft stenosis treated by percutaneous intervention

Abstract

Objective: This study aims to evaluate the clinical implications of radial artery graft stenosis and the performance of percutaneous intervention (PCI) of radial artery (RA) grafts.

Methods: Out of 291 patients, 18 (6.2%) underwent PCI of an RA graft. The indications for PCI were acute myocardial infraction (n=1), angina (n=10) and scintigraphic abnormality (n=5). Two patients were asymptomatic and underwent PCI prior to major extracardiac surgery. The location of the RA stenosis was proximal (n=2) or distal anastomosis (n=5) and body of the conduit (n=11). From 1992 to 2001, balloon dilatation alone was performed on nine RA grafts at 1.7 years after surgery. Since 1999, stenting of nine RA grafts was achieved at 9.2 years after surgery. Three bare-metal and six drug-eluting stents were implanted. Stent mean diameter and length were 2.75 mm and 16 mm, respectively. Simultaneous PCI of other coronaries was achieved in five cases.

Results: At 5.8 years, clinical follow-up showed heart failure (n=2) and recurrent angina (n=3), all after balloon dilatation. Control angiogram was performed in 14 cases at 4.5 years by conventional angiography (n=8) and 64-slice CT scan (n=6). One RA graft was occluded due to competitive flow from the native coronary vessel. Two RA restenoses following balloon dilatation were treated by stenting with long-term success (n=1) and secondary occlusion (n=1). Intra-stent RA stenosis was noted in one asymptomatic patient. All patients survived at long term except for one non-cardiac death at 5.9 years.

Conclusion: Focal stenosis of radial artery graft is a rare angiographic finding and its meaning is unequivocal. PCI with balloon alone should be restricted to the early postoperative period during which spasm is difficult to exclude. Stenting offers excellent and durable results and shall be preferred in most cases.