Intravascular ultrasound analysis of the radial artery for coronary artery bypass grafting.

Abstract

The radial artery has become a popular conduit for coronary artery bypass surgery. However, limited information has been provided regarding the atherosclerotic nature of this artery, which may affect both the immediate intraoperative difficulties and long-term graft patency. We examined intravascular ultrasound (IVUS) images of the radial artery in patients with coronary artery diseases. Cross sections of the radial artery were assessed using the following factors: lumen diameter, lumen area, vessel diameter, vessel area, plaque area, percent plaque area, and extent of calcium deposition. The IVUS images were obtained from radial arteries of 58 patients (47 men, average 67 +/- 9 years) during transradial procedures; ie, transradial coronary angiography and/or transradial coronary intervention. Mean luminal diameter was 3.28 +/- 0.69 mm and 3.00 +/- 0.70 mm at the proximal and distal segments, respectively, and 2.58 +/- 0.73 mm at the minimal lumen cross section. A percent plaque area greater than 50% was seen in five radial arteries (8.6%) whose average plaque length was 26.4 +/- 30.8 mm. Of these, one showed a plaque length greater than 50 mm, and another showed vessel caliber less than 2.0 mm. Five of 58 radial arteries (8.6%) showed calcium deposition, two of which showed diffuse calcification (> 50 mm). Thus, among 58 radial arteries, four (6.9%: one with diffuse arteriosclerosis, one small radial artery, two with diffuse calcification) were considered unsuitable for bypass conduit. Preoperative evaluation of the radial artery is recommended in order to prevent unnecessary exploration of the forearm and to improve graft patency.