This comprehensive review examined the application of the distal transradial approach (dTRA) in percutaneous coronary intervention (PCI). The dTRA, characterized by its unique anatomical access site in the anatomical snuffbox, demonstrates distinct features for both puncture and hemostasis techniques. dTRA offers several advantages compared with conventional transradial access, including shorter hemostasis time, reduced incidence of access-site hematoma and compartment syndrome, lower rates of radial artery occlusion, enhanced patient and operator comfort, and a potential for retrograde recanalization of the occluded radial arteries. However, it also presents challenges, including a steeper learning curve, limitations related to a smaller arterial diameter, and constraints in patients with taller stature or specific anatomical variations. Clinically, dTRA has been used in diverse patient cohorts, including patients with acute coronary syndrome, those undergoing complex PCI procedures, and individuals with preexisting radial artery occlusion. Although ongoing clinical controversies exist regarding its universal adoption, these could be addressed through technical refinements, standardized training, and device innovations. Future directions include optimizing procedural protocols, expanding evidence from randomized trials, and exploring technological advancements to enhance feasibility. Overall, this review summarizes and evaluates the current evidence to provide a foundational reference for the broader implementation and further investigation of dTRA in PCI.
Chen et al. (2026) studied this question.