Radial Artery Angiographic String Sign: Clinical Consequences and the Role of Pharmacologic Therapy

Radial artery conduit for coronary revascularization: as good as an internal thoracic artery?

“…In contrast, diffuse narrowing appears to be an autoregulated adaptive narrowing of the radial conduit in the setting of competitive flow [33]. Although the signaling mechanism by which flow competition provides a stimulus for graft dysfunction has not been well characterized, low flow and resultant low shear stress in the radial conduit may impair endothelial function.…”

Transatlantic editorial: A comparison between European and North American guidelines on myocardial revascularization

“…The text is short, but emphasizes that RAs are prone to spasm and/or atrophy when directed to a moderately rather than a severely narrowed coronary artery. It is well recognized that arterial grafts including the RA may fail not only by occlusion but can also remain patent while becoming extremely narrowed and non-functional (string sign) [21]. Evidence exists that the RA is probably more dependent on the severity of the proximal target vessel stenosis than the IMA [22,23].…”

Searching for the Second-Best Coronary Artery Bypass Graft

“…5 In another recently published report by these investigators, they suggest that this diffuse narrowing of the radial artery grafts is of little or no clinical consequence. 7 They base this opinion on the findings of quantitative angiograms performed on some of these narrowed radial artery grafts, in which Thrombolysis in Myocardial Infarction (TIMI) grade 2 or 3 flow was seen. Postoperative symptoms of inadequate graft flow were observed in only those 15 patients with a string-sign radial artery graft and TIMI grade 1 flow.…”