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.