Fig. 1

Steps of trans-brachial approach. a, b Proper sterile preparation of the antecubital fossa with a povidone iodine solution. c Subdermal injection of 2% xylocaine solution above the elbow crease. d The brachial artery punctureutilising either the single puncture approach or the modified Seldinger method. e, f Advancement of a 30 cm guidewire. g–i insertion of an arterial sheath over the wireand confirmed by fluoroscopy. j, k RCA and LMCA engagement via trans-brachial approach. l Removal of the arterial sheath followed by direct digital compression to the brachial artery for 10 min to achieve hemostasis. m Maintain the arm in such position for 4–6 h