Dear Editor,

We read with great interest the article by Spargias et al.¹ entitled Percutaneous Coronary Intervention in Anomalous Right Coronary Arteries Arising from the Left Sinus of Valsalva: A Report of Two Cases and Observations on the Pattern of Atherosclerosis (J Invasive Cardiol 2006 18:E78–E81). The authors report a total of 31 such cases in the literature, but they did not comment on our case series in which we reported on the use of the right radial approach.² This omission is regrettable since percutaneous intervention of anomalous right coronary arteries from the femoral approach is technically challenging and frequently requires use of guide catheters designed for the left coronary that do not provide adequate backup and are difficult to seat in a coaxial fashion in the right coronary. As the authors point out, this may require multiple catheter exchanges, prolonged fluoroscopy time and large amounts of contrast injection. The right radial approach may be preferred in this setting since conventional right coronary guides can be used and provide excellent visualization and support. Furthermore, transradial access for coronary interventions is now a well-established technique which can be used with contemporary anticoagulant regimens^3–5 and operators who are experienced with this technique should be reminded that the right radial approach is an excellent alternative to a prolonged intervention from the femoral approach in patients with anomalous right coronary arteries arising from the left sinus of Valsalva.