Use of different access sites for coronary intervention have been changing over the last several decades. Access changed from transfemoral to transradial approach (TRA), as it has proven to have less access site complications, decreased mortality rate and is cost-effective compared to the transfemoral approach. In 2015, the European Society of Cardiology guidelines for the management of acute coronary syndrome gave class I recommendation to use the TRA as the preferred method of access for any percutaneous coronary intervention irrespective of clinical presentation . However, the use of TRA is associated with certain complications: radial artery occlusion (RAO), radial artery spasm, radial arterial perforation, radial artery pseudoaneurysm, arteriovenous fistula, bleeding, nerve damage, and complex regional pain syndrome. In the past few years there are publications who showed safety, feasibility and lower access site complications when using distal radial access (dTRA) for cardiac catheterization . However limited data is available regarding the technique of distal radial artery access in patients presenting with Acute coronary syndrome, treated with primary percutaneous coronary intervention. This study investigated the feasibility, safety, and potential benefit of dTRA in patients acute coronary syndrome. 152 patients had primary PCI through distal transradial access. The success rate of the puncture  was 98.7% (150/152).  Rate of radial artery occlusion  0%, and local hematoma according to EASY score ( grade I: 15.13%, grade II; 0%, grade III : 0%, grade IV,: 0%, Radial artery spasm  ( grade I  7.2%, grade II  2.7%, grade III 1.3%, grade IV 0%  ) access site crossover  2 patients), access time 38.6 sec,time of hemostasis  30-60 min.

Conclusion: dTRA is safe and successful in patients with acute coronary syndrome, when performed by experienced radial operators, with previous experience with dTRA.