In 1948, Radner [1] was the first to describe transradial catheterization using radial artery cut-down. Probably due to the limitations of this technique and the limited size of the radial artery, use of larger arteries were explored. In 1953 Seldinger reported on non selective coronary angiography by percutaneous femoral approach [2] It was Mason Sones Jr. who introduced selective coronary angiography by cutdown arteriotomy of the brachial artery in the early sixties of the previous century [3]. This technique became the standard approach for decades. The first percutaneous transfemoral selective coronary angiograms were introduced by Ricketts and Abrams in 1961 [4]. By development of a special set of preshaped catheters for percutaneous transfemoral coronary angiography, Melvin Judkins popularized this technique [5].

Lucien Campeau from the Montreal heart Institute reactivated Radner’s idea in order to overcome the shortcomings and complications of brachial artery cutdown. In 1964 he reported on radial artery access by arteriotomy of the proximal radial artery [6]. In 1989 Campeau published a paper on percutaneous entry into the distal radial artery for selective coronary angiogiography using a 5 F sheath and pre-shaped catheters in 100 patients [7]. In ten patients radial artery access was impossible and in another two patients the coronary arteries could not be catheterized. This paper was published in those years when the interventional cardiologists worldwide were coping with the serious and frequent bleeding complications associated with transfemoral coronary stenting. Years later, in 1992 another paper on transradial coronary angiography was published by Dr. Otaki, Department of Cardiovascular Surgery, Osaka National Hospital, Japan [8]. Out of 40 patients, 39 patients underwent successful coronary angiography with five Fr catheters.

In the same year of Dr. Campeau’s publication, Kiemeneij et al. introduced the coronary use of Palmaz Schatz stents at the Onze Lieve Vrouwe Gasthuis in Amsterdam, which had to be inserted femorally via 8 and 9 F guide catheters. The unacceptable high incidence of severe and sometimes fatal local bleeding complications under aggressive anticoagulation regimens and during and after prolonged bed rest following sheath removal [9] was their major reason to use Dr. Campeau’s work as the basis for developing transradial coronary interventions and stent implantation. The superficial course of the radial artery, the ease of compression, the absence of major structures near the radial artery and the double blood supply to the hand, made the radial artery theoretically the most ideal site to introduce catheters in patients who required intense postprocedural antiocoagulation strategies. The small size of the artery did not allow use of 8 F guides however. Although at that time it was unthinkable to place stents through 5 F catheters it was just a matter of time before the first 6 F guides became available in the Netherlands in 1992. That year the first patient underwent successful transradial coronary balloon angioplasty for an LAD stenosis. Early 1993 the first (hand crimped) Palmaz Schatz coronary stent was placed successfully via a 6 Fr guide inserted in the radial artery in a patient with an ostial venous bypass graft stenosis. This pioneering phase was characterized as a single operator, and later a single center experiment when Drs Laarman, Slagboom and van der Wieken joined. Much emphasis was placed on training of nursing staff at the catheterization laboratory. There were no dedicated needles, sheaths, catheters and hemostasis devices available and the technique had to be developed from zero. The main goal was to increase safety of coronary stenting. The frontiers and limitations were yet unknown and had to be explored. Radial artery spasm, complex anatomy of the arm vasculature, late radial artery occlusions all had to be overcome. Results however were impressive enough to continue exploration of this technique. A patient could walk immediately after stent placement and nobody needed to worry about access site bleeding complications. These very first results were presented during the 66th scientific sessions of the AHA in 1993 in the form of a poster and early publications [10–12]. Although it drew modest attention, the poster presentation ignited international interest and it was the start of a new “movement” in interventional cardiology. Those who believed the message just started to build up experience, received training at the OLVG or started own training programs.

The pioneering single center phase now gradually started to internationalize. Dr. Jean Fajadet and Dr. Yves Louvard visited the OLVG early 1994 to see the application of TRI with their own eyes [13]. Only 2 weeks later Dr. Fajadet showed a live demonstration from Toulouse to the TCT Washington. This really ignited the international breakthrough. Thousands of interventional cardiologists witnessed for the first time a transradial coronary stent procedure, followed by immediate mobilization of the patient. The reactions were overwhelming.

Simply based on the attractive applied anatomy of the radial artery, more and more operators started to realize that the great promise of TRI was the reduction of major access site bleeding and thus resulting in less mortality, increased safety and patient comfort and in a reduction of costs. It can be said that in the first 50 papers published from 1992 to 1997, all these promises were demonstrated to hold and initial limitations and barriers were progressively torn down. The ACCESS [14] study was the first randomized study showing equivalence between radial, femoral and brachial access. The technique proved to be applicable for most patient subsets and most forms of coronary pathology. A growing number of radialists started to join, organizing dedicated meetings all over the world, the first one held in Amsterdam in 1995. It resulted in a challenging phase of exploration, education and development of dedicated TRI materials. Opposition, criticism and reluctance to restart a new learning curve by “femoralists” had to be overcome. Radial congresses emerged all over the world and were true reunions, meetings of friends, a perfect mix of exchanging information and experience with celebration of mutual recognition. The “Radial Revolution” became a fact.