Trans-radial access (TRA) has been established as a safer and superior to femoral artery access for percutaneous coronary procedures(1–3). This is due to its lower risk of bleeding and vascular complications, as well as faster post procedure recovery. TRA is associated with better quality of life and allows safe performance of same-day discharge for diagnostic and interventional procedures in stable patients, contributing to overall cost-effectiveness(4,5).

Radial artery occlusion (RAO) is by far the most frequent complication of TRA, with highest incidence in the first 24 hours and spontaneous recanalization at 30 days in only about one-half of the patients. Its incidence varies from 0.8 to 10% at 24 hrs and up to 5.5% at 30 days of follow-up(6–10). An occluded radial artery as such is unsuitable for a future percutaneous coronary or noncoronary procedures. In light of the increasing use of TRA in numerous interventional procedures, prevention of RAO is becoming a central consideration for achieving a successful radial program.

There is a growing interest in the distal trans radial artery access (dTRA) as an alternative to conventional TRA, with multiple studies reporting feasibility since its first public introduction in 2017(11). dTRA in the anatomical snuff box or the dorsum of the hand has emerged as a promising alternative access to reduce the risk for RAO because of the puncture site being beyond the hand anastomotic network, which most likely ensures persistent blood flow in the radial artery. It has also been shown to be associated with less pain and lower incidence of compartment syndrome as compare to TRA and has shown to improve both patient and operator comfort, especially when using the left radial, as there is no disagreeable forearm supination.  Recently published randomized control trials (RCT) have shown striking reductions of RAO after dTRA compared with conventional TRA(10,12,13), whereas, the multi-centered DISCO RADIAL study did not show a significant difference in RAO, but did demonstrate a significantly shorter hemostasis time with dTRA(7). There is no evidence for or against the use of dTRA during PCI from Indian subcontinent.

To further unravel the role of dTRA in current interventional practice in India, a prospective, multicenter randomized control trial is planned to compare the outcomes of dTRA and conventional TRA used for percutaneous coronary intervention.