Coronary artery bypass grafting (CABG) is the primary surgical treatment for coronary artery disease (CAD). However, long-term clinical practice has confirmed the poor long-term patency of saphenous vein grafts (SVG), prompting surgeons to investigate alternatives, such as the use of radial artery (RA) grafts. In this report, we review and discuss the current status of radial artery application during CABG and current controversies in the field. Ultimately, evidence indicates that RA-CABG is associated with good long-term patency and is suitable for patients with severe stenosis. However, the compensatory capacity of the ulnar artery should be assessed prior to RA harvesting. Given that the RA is prone to spasms, routine application of calcium channel blockers is recommended. Several studies also have indicated that sequential grafting is an effective method for maximizing radial artery application and that patency rates are similar for the radial artery and right internal mammary artery. In contrast, the use of the bilateral internal mammary arteries is technically more demanding and exhibits a significant volume-outcome relationship. The decision to use the right internal mammary artery or radial artery should be based on individual patient characteristics and the experience of the surgical team.