Randomized Comparison of Vasodilator Effects of Iloprost versus Diltiazem on Flow and Pathologic Changes in Radial Arteries: Mid-term Angiographic Control Study of the Comparison of Vasodilators on Radial Artery Vasospasm
Background: The increasing prevalence of routine radial artery (RA) use in coronary artery bypass grafting (CABG) has rendered the pharmacologic prevention of spasm of this artery a critical consideration in the early postoperative period and in the long-term outcome. In this study, we compared the effects of iloprost and diltiazem on vasospasm.
Methods: Seventy patients who underwent CABG with the RA were randomized into 2 groups, and the vasodilator effects of iloprost and diltiazem were studied prospectively. RA flow was measured with Doppler ultrasonography. Following harvesting, a 5-mm piece was removed from the RA distally for pathologic examination. In group B, diltiazem was infused before removing the RA, whereas in group A, iloprost infusion was initiated 5 days before surgery. At the end of a 2-year follow-up, each patient underwent coronary angiography.
Results: Doppler flow measurements made during harvesting revealed a statistically significant reduction in flow, and a pathologic examination of the RAs revealed significant luminal narrowing in group B. A 2-year angiographic follow-up revealed all of the RA grafts in group A to be patent.
Conclusions: Our evaluation of the results revealed the superior efficacy of iloprost over diltiazem in preventing RA spasm in the early period, and the 2-year angiographic findings showed that the use of iloprost produced superior mid-term patency.
Acar C, Jebara VA, Portoghese M, et al. 1991. Comparative anatomy and histology of the radial artery and the internal thoracic artery. Implication for coronary artery bypass. Surg Radiol Anat 13:283-8.nAcar C, Jebara VA, Portoghese M, et al. 1992. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 54:652-9.nAmano A, Takahashi A, Hirose H. 2002. Skeletonized radial artery grafting: improved angiographic results. Ann Thorac Surg 73:1880-7.nBarner HB. 1998. Arterial grating: techniques and conduits. Ann Thorac Surg 66:S2-5.nBarner HB. 2002. Remodelling of arterial conduits in coronary grafting. Ann Thorac Surg 73:1341-5.nBhan A, Gupta V, Choudhary SK, et al. 1999. Radial artery in CABG: could the early results be comparable to internal mammary artery graft? Ann Thorac Surg 67:1631-6.nCarpentier A, Guermonprez JL, Deloche A, Frechette C, DuBost C. 1973. The aorta to coronary radial artery bypass graft: a technique avoiding pathological changes in grafts. Ann Thorac Surg 16:111-21.nChanda J, Brichkov I, Canver CC. 2000. Prevention of radial artery graft vasospasm after coronary bypass. Ann Thorac Surg 70:2070-4.nda Costa FD, da Costa IA, Poffo R, et al. 1996. Myocardial revascularization with the radial artery: a clinical and angiographic study. Ann Thorac Surg 62:475-80.nDeshpande RP, Chukwuemeka A, Iqbal A, Desai JB. 2000. Dystrophic calcification of the radial artery. Ann Thorac Surg 69:1939-40.nDrinda S, Neumann T, Pohlmann G, et al. 2005. The response of skin perfusion and of rheological and immunological variables to intravenous prostanoid administration in Raynaud's phenomenon secondary to collagenosis. Vasa 34:243-9.nHe GW, Yang CQ. 1997. Radial artery has higher receptor mediated contractility but similar endothelial function compared with mammary artery. Ann Thorac Surg 63:1346-52.nHe GW, Yang CQ. 1998. Characteristics of adrenoceptors in the human radial artery: clinical implications. J Thorac Cardiovasc Surg 115:1136-41.nHe GW, Yang CQ. 2000. Comparative study on calcium channel antagonists in the human radial artery: clinical implications. J Thorac Cardiovasc Surg 119:94-100.nKaufer E, Factor SM, Frame R, Brodman RF. 1997. Pathology of the radial and internal thoracic arteries used as coronary artery bypass grafts. Ann Thorac Surg 63:1118-22.nKobzar G, Mardla V, Jarving I, Samel N. 2001. Comparison of anti-aggregatory effects of PGI2, PGI3 and iloprost on human and rabbit platelets. Cell Physiol Biochem 11:279-84.nLocker C, Mohr R, Paz Y, et al. 2002. Pretreatment with a-adrenergic blockers for prevention of radial artery spasm. Ann Thorac Surg 74:S1368-70.nLowe HC, Macina A, Torosoff M, Millar RD. 2002. Recurrent spasm of radial artery graft mimicking fixed stenosis. J Invasive Cardiol 14:640-1.nManabe S, Sunamori M. 2006. Radial artery graft for coronary artery bypass surgery: biological characteristics and clinical outcome. J Card Surg 21:102-14.nManabe S, Tanaka H, Yoshizaki T, Tabuchi N, Arai H, Sunamori M. 2005. Effects of the postoperative administration of diltiazem on renal function after coronary artery bypass grafting. Ann Thorac Surg 79:831-6.nMoran SV, Baeza R, Guarda E, et al. 2001. Predictors of radial artery patency for coronary bypass operations. Ann Thorac Surg 72:1552-6.nNicolosi AC, Pohl LL, Parsons P, Cambria RA, Olinger GN. 2002. Increased incidence of radial artery calcification in patients with diabetes mellitus. J Surg Res 102:1-5.nRoyse AG, Royse CF, Tatoulis J, et al. 2000. Postoperative radial artery angiography for coronary artery bypass surgery. Eur J Cardiothorac Surg 17:294-304.nScorza R, Caronni M, Mascagni B, et al. 2001. Effects of long-term cyclic iloprost therapy in systemic sclerosis with Raynaud's phenomenon. A randomized, controlled study. Clin Exp Rheumatol 19:503-8.nVelez DA, Morris CD, Muraki S, et al. 2001. Brief pretreatment of radial artery conduits with phenoxybenzamine prevents vasoconstriction long term. Ann Thorac Surg 72:1977-84.n
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