The radial artery (RA) graft was revived in late 1980 s when it was found that the graft was patent 13-18 years after coronary artery bypass grafting (CABG) after improvement of the technique in harvesting and the use of calcium-channel blockers. Recently, the RA became a reasonable alternative to the saphenous vein (SV) graft with the trend toward complete arterial revascularization and more frequent off-pump CABG to avoid aortic manipulation. To improve the quality of the RA conduit, harvesting technique and topical and systemic antispasmodic medication are important. The RA should be grafted to severe proximal stenosis (>90%) in the native coronary arteries to avoid flow competition, especially in the right coronary territory. The RA graft could be used as an aortocoronary or composite configuration with similar graft patency. Early graft patency of the RA conduit was as good as other arterial grafts, and better than SV graft in the circumflex and right coronary territories, in many studies, especially in diabetic patients. Long-term results of graft patency and cardiac-event-free survival compared with SV graft are still controversial in randomized controlled trials, probably because the incidence of flow competition and the definition of graft patency varied. (Circ J 2009; 73: 1178-1183)