...a single arterial access was used in most cases in this series, yet dual arterial access is recommended for most CTO PCIs (unless there are no contralateral collaterals) to optimize the efficacy and safety of the procedure.12,13 Third, the incidence of radial artery occlusion was not assessed. Both dTRA and TUA were associated with procedural outcomes equivalent to those of proximal TRA, supporting their use in CTO PCI.Declaration of Competing Interest Dr. Brilakis declares consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Amgen, Asahi Intecc, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, and GE Healthcare (Little Chalfont, United Kingdom), IMDS, Medicure, Medtronic, Siemens, and Teleflex; research support: Studies Technical success (dTRA vs TRA) Procedural success (dTRA vs TRA) In-hospital MACCE (dTRA vs TRA) Vascular complications (dTRA vs TRA) Poletti et al (Present study) 92% vs 95% (p = 0.50) 92% vs 94% (p = 0.70) 4% vs 1.9% (p = 0.60) 2.0% vs 2.9% (p >0.90) Lin et al (2021) 94%* 94%* 0.7%* 3.7%* Nikolakopoulos et al (2021) 91% vs 86% (p = 0.014) 91% vs 84% (p = 0.05) 0.8% vs 2.4% (p = 0.26) 1.3% vs 2.3% (p = 0.09) Achim et al (2022) 91% vs 83% (p = 0.161) 88% vs 80% (p = 0.664) 3.8% vs 4.3%† (p = 1) 3.8% vs 5.1% (p = 0.820) Table 1 Comparison of distal with proximal radial access for CTO PCI