Clinical and Potential Use of Pharmacological Agents to Reduce Radial Artery Spasm in Coronary Artery Surgery

Conduit Selection for Improved Outcomes in Coronary Artery Bypass Surgery

“…Vasodilation of the harvested RA should begin intraoperatively by exposing the conduit to papaverine or verapamil/nitroglycerin. Verapamil/nitroglycerin may be more effective than papaverine in regards to degree of vasodilation and preservation of endothelial function, which can be a problem with papaverine (especially if injected intraluminally) and with the alpha-blocking agent phenoxybenzamine [118]. Postoperatively, most authors have recommended vasodilation with calcium channel blocking agents or long-acting nitrates for at least one month after surgery.…”

“…Subsequently, several RA grafts were empirically observed to be patent at follow-up coronary angiography, leading to the concept's reintroduction in the late 1980s [117]. Since then, the RA has since been widely used and aggressively investigated as a conduit option for CABG due to ease of use, availability in at least 90% of patients, good length allowing reach to any distal target for anastomosis, and it is amenable to concurrent harvesting methods (the IMA, SVG, and RA can be harvested simultaneously) [118]. Depending upon the details of RA grafting, including the target coronary bed and the proximal degree of coronary artery stenosis, long-term RA graft patency approaches 90% and can approximate that of pedicled IMA graft patencies [55,119,120].…”

Potent Vasodilatory Effect of Fasudil on Radial Artery Graft in Coronary Artery Bypass Operations

“…The potential of the radial artery (RA) as an arterial conduit in coronary artery bypass grafting (CABG) was first reported in 1973 [1,2]. However, the use of RA in CABG was soon abandoned because of vasospasm leading to early occlusion.…”

Pharmacology of Arterial Grafts for Coronary Artery Bypass Surgery

“…RA studied in vitro was found to relax fully either to GV solution or to papaverine, but the relaxation to GV solution was more rapid in onset and of longer duration than for papaverine [62]. GV (GTN +Verapamil) solution has been found to be satisfactory when is used on the RA to dilate it during harvesting and preparation and it [11,129]. It can be argued that GV solution represents the optimum agent for RA spasm when used in the perioperative period [129].…”

“…GV (GTN +Verapamil) solution has been found to be satisfactory when is used on the RA to dilate it during harvesting and preparation and it [11,129]. It can be argued that GV solution represents the optimum agent for RA spasm when used in the perioperative period [129]. It has been suggested that a 'cocktail' of agents may be given to counteract RA spasm before transradial coronary angiography or angioplasty [130].…”