OBJECTIVE: The purpose of the present study was to evaluate the hypothesis that angioplasty from the radial artery approach is more cost effective than that from the femoral artery approach. BACKGROUND: Previous studies have demonstrated that angioplasty can safely and effectively be performed from the radial artery approach with a virtual absence of access-site complications. METHODS: One-hundred fifty-two patients were prospectively randomized to have their angioplasty performed from either the radial or femoral approach. Angioplasty results as well as various cost factors were compared. RESULTS: Primary success, number of stents deployed, emergency bypass surgery, PTCA time, fluoroscopy time, amount of contrast media, and catheterization laboratory charge were not significantly different in the two groups. Access-site complications (0 RRA vs. 4 RFA, p <.04), post-procedure length of stay (2.1 days +/- 0.1 RRA vs. 2.6 +/- 0.3 RFA, p <.04), total hospital length of stay (3.6 days +/- 0.2 RRA vs. 4.5 +/- 0.4 RFA, p <.03), and total hospital charge ($14,374 +/- 467 RRA vs. 15,796 +/- 702, p <.05) were all significantly less in the radial group. CONCLUSION: PTCA can be performed from RRA as effectively as RFA without clinically significant access-site complications. Both post-procedure and total hospital stay are reduced, leading to a 9% reduction in total hospital charges.