Objective — to compare traditional and distal radial approaches in percutaneous coronary interventions regarding incidence of complications, soreness and convenience for surgeon. Material and methods. A two-center prospective study was performed. There were 235 patients after percutaneous coronary interventions through the radial approach. Mean age was 62.3±11.2 years. There were 167 (71%) men and 68 (29%) women. Radial artery puncture in the lower third of the forearm was made in 88 (37%) patients (group — “RA_l/3”), distal radial access was used in 147 (63%) patients (group — “RA_distal”). Intraoperative approach-associated technical difficulties were considered. Severity of pain syndrome was analyzed intraoperatively and in 1 day after surgery using a 10-score scale. Local complications were considered within 7 days (RA occlusion, aneurysm/arterio-venous fistula of the RA, perforation/dissection /avulsion of the RA, local hematoma over 15 cm2, local infection). In-hospital mortality and major adverse events were monitored (myocardial infarction, stroke). Results. Technical difficulties caused by the access were noted in 2 (2%) patients in the «RA_l/3» group and in 7 (5%) patients in the «RA_distal» group (p=0.49). Severity of intraoperative pain syndrome was assessed as 2 (1; 3) scores in the «RA_l/3» group and 3 (1; 3) scores in the “RA_distal” group (p=0.01). A day later, these values were 2 (1; 3) and 1 (1; 3) score, respectively (p=0.85). Local complications in the «RA_l/3» group were observed in 19 (22%) patients, in the «RA_distal» group — in 17 (12%) patients (p=0.04). Major adverse events were detected in 3 (3%) patients in the «RA_l/3» group and in 5 (3%) patients in the «RA_distal» group (p=1.00). Conclusion. RA puncture in the lower third of the forearm results higher incidence of local complications compared with distal radial access. Distal radial approach is associated with more severe intraoperative pain syndrome. There were no differences in the incidence of major adverse events, mortality and technical difficulties.