Radial artery access in interventional cardiology: a review of current practices

Abstract

Transradial access (TRA) has evolved from an alternative technique to the guideline-recommended default strategy for coronary angiography and percutaneous coronary intervention. This shift is driven by TRA’s association with improved clinical outcomes, fewer complications, and enhanced patient comfort compared with transfemoral access (TFA). The evolution of transradial techniques, including distal radial access (DRA), reflects a broader move towards minimally invasive, patient-centered interventional cardiology. This narrative review synthesizes data from 50 peer-reviewed articles retrieved from PubMed, Scopus, and Web of Science, including randomized controlled trials, meta-analyses, observational studies, and expert consensus statements. Key topics examined include anatomical considerations, comparisons between left and right radial access, comparisons between TRA and TFA, the emerging role of DRA, special considerations in certain populations, procedural complications, and cost analysis. TRA represents a major advancement in interventional cardiology, enhancing safety, efficiency, and patient satisfaction. Its incorporation into routine practice improves outcomes and procedural ergonomics. Despite certain anatomical and technical challenges, robust evidence supports TRA as the default strategy for coronary interventions across most patient populations. Ongoing investigations and trials continue to define optimal procedural techniques and patient selection criteria. These data are expected to further standardize clinical practice and support more consistent, high-quality outcomes across centers.