Abstract Body (Do not enter title and authors here): Introduction/Background: Use of the radial artery (RA) is associated with better clinical outcomes compared to the saphenous vein during coronary artery bypass grafting (CABG) and is strongly endorsed by society guidelines. While the safety of using the RA as a sequential T-graft from the internal mammary artery is established, evidence on the safety and efficiency of sequential radial artery grafts directly from the aorta is limited. Research Questions/Hypotheses: The use of a sequential radial artery originating on the aorta is safe and efficient and is associated with an increase in the number of arterial grafts used in patients undergoing CABG. Goals/Aims: To evaluate the safety and efficiency of using the radial artery in a sequential approach directly from the aorta during CABG.Methods: STS database analysis of patients undergoing isolated CABG with ≥1 RA by one surgeon at two centers (2001-2022). Patients with sequential vs. non-sequential RA grafting were compared. Primary outcomes included CPB and cross-clamp time, total number of arterial grafts, and incomplete revascularization. Secondary outcomes were 30-day mortality, reoperation, stroke, renal failure, sepsis, ICU length of stay, and deep sternal wound infection. Statistical methods included Mann-Whitney U test, Chi-Square test, and Optimal Matching Propensity Score analysis (1:3 ratio)..Results: Of 503 patients who received an RA graft, 129 (25.6%) were sequential. Before matching, significant differences were noted in median age, BMI, CPB and cross-clamp (XC) time, and elective status between groups. Sequential RA use was associated with a higher median number of arterial grafts and total grafts (3 vs 2, and 4 vs 3, respectively, p<0.001 for both). Following propensity score matching (SMD <0.1, n=125 sequential and 370 non-sequential), baseline characteristics were similar. Matched patients with sequential RA and ≥5 grafts had significantly shorter median CPB and cross-clamp time (142 [135–161] vs. 164 [164–164] min, and 113 [107–122] vs. 137 [124–137] min, p<0.001 for both), higher number of arterial grafts and total arterial grafting (p<0.001 for both), and lower rates of incomplete revascularization (17/125 vs. 83/370, p=0.046). No differences were observed in clinical outcomes between matched groups.