Today, new technologies and methods are emerging in the development of coronary interventions, but the first step in the use of various interventional techniques – the establishment of arterial access – is inevitable. In the past, most interventions were performed by femoral artery puncture, but more than 10 years ago, radial artery puncture was introduced. Since patients do not need to rest in bed after radial artery puncture and can get down to the floor soon after the procedure, it is favored by many patients, and the chance of local complications from puncture is also smaller. However, we cannot conclude that radial artery puncture is “more advanced” than femoral artery puncture, and in fact it cannot completely replace femoral artery puncture. The radial artery route has some inherent disadvantages. First, the radial artery has a small diameter and is prone to intraoperative spasm, especially in small female patients, which can cause pain, affect the operation and prolong the operation time, or lead to failure to withdraw the catheter. Secondly, some patients have luminal stenosis caused by intimal hyperplasia of the radial artery after surgery, which is manifested by the weakening or even disappearance of the radial artery pulsation, and this causes difficulties in diagnosing the pulse in Chinese medicine in the future. For patients with chronic renal insufficiency, who are estimated to require hemodialysis treatment, it is best not to use the radial artery pathway in order to leave the radial artery intact for future fistula dialysis. Third, those who have not been formally treated for hypertension for many years often have significant bending of the subclavian artery, which may result in catheter inability to pass or difficulty in manipulation, and finally the radial artery route has to be abandoned. Fourth, the transradial route, the catheter support is not as strong as the femoral route and cannot provide sufficient support in case of coronary artery bending or complex lesions leading to operation failure. Fifth, because of the small size of the radial artery, it can only accommodate a 6F catheter (2 mm internal diameter), which makes it relatively inconvenient to operate if counter-anastomotic dilation or counter-anastomotic stenting is required, and impossible to perform if intravascular ultrasound or rotary grinding therapy is required or if special techniques such as distal vessel protection devices (requiring a 7F catheter or higher) are needed. The end result is either to perform a puncture from the femoral artery instead or to get only a treatment that is not the best option. As can be seen, the radial artery puncture route cannot completely replace the femoral artery route. The radial route should be considered if the patient has severe stenosis, curvature, or aneurysm of both femoral or iliac arteries, or arterial entrapment that makes femoral artery puncture impossible or increases the risk. The radial route should also be considered first if the patient has cardiac insufficiency, respiratory problems, or lumbar spine problems that prevent prolonged ambulation (arterial closure devices are now available, partially solving the problem of prolonged ambulation after femoral artery puncture). In conclusion, the purpose of coronary intervention is to resolve the lesions of the coronary arteries, and the choice of different pathways is only a minor secondary issue, so patients do not need to put the cart before the horse and get entangled in the puncture route.