Calcium-Channel Blockers in Patients with Radial Artery Grafts.

The use of radial artery (RA) grafts for coronary bypass surgery has recently gained newer attention since it has been associated with significant reduction in the risk of midterm cardiac events. Surprisingly the use on the RA graft as second ‘best’ conduit has been limited among the surgical community. There may be several explanations for the little popularity of the RA graft; one of the reasons that could prevent surgeons to include the RA in the daily surgical armamentarium it is that patients with RA grafts may require postoperative calcium-channel blocker (CB) therapy. Due to the thick muscular wall, it seems possible that the RA would needs CB in order to prevent spasm and ameliorate patency. CBs are, however, associated with important side effects; also they have hypotensive effect that can hamper the use of other therapy such as beta-blocker or angiotensin-converting enzyme inhibitors. The evidence supporting the use of CB after RA graft (either in the early phase or as chronic calcium-blocker (CCB)) is weak. A the post-hoc analysis from the ‘RADIAL’ (Radial Artery Database International ALliance), showed that in patients with RA, the use of CB for at least 12 months was associated with better clinical and angiographic outcomes at mid-term follow-up, but confounders and bias may be responsible for the reported findings (as healthier patients are more likely to tolerate CB) . This review aims to summarize current evidences available on the topic and to serve as benchmark for evidence-based decision-making for CB prescription after RA grafting.