The transradial approach (TRA) has become the standard vascular access approach for diagnostic and interventional coronary procedures [1] . Not uncommonly, proximal radial artery occlusion (PRAO) is a complication of TRA, with the highest incidence in the first 24 h [12] . PRAO does not appear to have clear clinical consequences; however, the occluded radial artery cannot be used in the future for access, a conduit for coronary artery bypass grafting, or for creation of arteriovenous fistula in patients who require hemodialysis [12] . The distal transradial approach (dTRA) was introduced as an alternative access to reduce the risk of PRAO as it utilizes the radial artery at the level of anatomic snuff box [13] . Multiple studies have investigated the role of dTRA to reduce PRAO, but most of them were underpowered to detect true benefits with dTRA versus conventional TRA (cTRA) approaches.