Although the internal mammary artery (IMA) as a coronary graft offers better long-term patency than the saphenous vein, a factor limiting its use has been the length of the artery's pedicle. In an attempt to overcome this limitation, we evaluated the use of retrograde right IMA in a prospective study. In ten patients scheduled for routine coronary artery bypass surgery, bilateral IMA grafting was used, the left IMA in routine fashion, but the right IMA dissected from the level of the first rib, cut there and placed as an inverted graft. Three months postoperatively the patients were clinically evaluated with stress exercise test (n = 10) and coronary angiography (n = 9). No patient had recurrence of angina. Angiography revealed patency of the retrograde right IMA graft in six of nine patients. On the basis of these data we do not recommend routine use of retrograde IMA.