In most categories of patients and in virtually all diabetics, interventional therapy has advantages over medical therapy for amelioration of angina, a return to normal lifestyle, and probable prolongation of life. Coronary artery bypass surgery is indicated if angio-plasty or stenting are not possible, particularly in patients with an ejection fraction of less than 45%, and in diabetics.
When coronary artery bypass surgery is selected, patients who can receive an internal mammary artery graft are most fortunate. The arterial graft has a prolonged patency of 15–20 years versus approximately 10–12 years for saphenous vein grafts. Khot et al. have recently shown that radial artery bypass grafts have an increased occur¬rence of angiographically severe stenosis and occlusion compared with left internal mammary artery grafts and saphenous vein grafts (see the chapter Coronary Artery Bypass Surgery).

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