BACKGROUND Use of the radial artery for coronary artery bypass grafting is controversial. METHODS Between November 1992 and December 1994, the radial artery artery graft was used in 165 patients (mean age, 63.7 years) undergoing coronary revascularization. To prevent spasm, the radial artery was not skeletonized, and calcium-channel blockers were administered routinely. RESULTS No ischemic or functional complications occurred in the hand after harvesting of the radial artery. Only 1 patient (0.6%) sustained a perioperative myocardial infarction in an area revascularized with a radial artery. The overall mortality was 3.0% (5 patients), but no deaths were caused by failure of the radial artery graft. During a mean follow-up of 14.0 months, angina recurred in 5 patients (3.0%), all of whom had widely patent radial artery grafts on angiography. Radionuclide exercise studies were performed 1 year after operation in 84 patients, 2 of whom (2.4%) had stress-induced defects in areas grafted with a radial artery. CONCLUSIONS Perioperative myocardial infarction, mortality, and recurrent angina usually were not related to failure of the radial artery graft. Our results suggest that the radial artery is an excellent alternative conduit for myocardial revascularization and may be used safely, especially in patients with poor-quality or unavailable saphenous veins.