Our aim is to compare between right and left radial approach in patients undergoing percutaneous coronary procedures regarding feasibility and complications.

The radial artery has progressively became the standard access site for percutaneous coronary procedures both diagnostic and interventional. The first trans-radial access for cardiovascular diagnostics dates to 1947.

In 1989, the first case series of 100 coronary angiographies performed through the radial access, demonstrating the safety and the fast mobilization of patients with the radial approach .

The main advantages of the radial approach are increased safety and comfort of the patients with reduction of bleeding complications and immediate post-procedure ambulation .with these advantages, current guidelines highly recommend radial access for coronary angiography and percutaneous coronary intervention.

Most clinical trials focused solely on the right radial approach and rarely consider the left radial approach. Indeed, the RRA has technical obstacles related to anatomy and clinical practice like increased incidence of tortuosity of the subclavian artery and radial-ulnar artery loop with the right radial approach.

Most operators use the right radial access as the left radial access increase operator discomfort during vascular access and procedure, especially in obese patients.

However, the left radial access has potential benefits for both the patient and operator. One of which is that the left radial approach is associated with lower fluoroscopy time compared with the right radial approach.

Left radial artery as well is an appropriate alternative access for coronary catheterization with less anatomical variations like tortuosity than the right radial artery Moreover, left radial access is preferred for right handed patients because of temporary post-procedural disability caused by hemostasis process in right radial artery access Also subclavian artery tortuosity is significantly more common on the right side and is an important cause of difficult, prolonged, or failed radial procedure.

Inclusion Criteria:

• • All patients presented to assiut university cardiac catheterization laboratory and eligible for radial coronary procedures (either diagnostic or interventional )

Exclusion Criteria:

• • Patients with acute coronary syndrome.

  • Patients with chronic upper limb ischemia
  • Patients with AV fistula
  • Patients with severe renal impairment
  • Failure to successfully cannulate the radial artery

Patients undergoing coronary angiography or elective PCI in assiut university heart hospital.