Transradial access for percutaneous coronary intervention (PCI) has demonstrated clinical advantages over transfemoral access, with reduced bleeding complications and mortality. However, concerns about radial artery occlusion (RAO) and the small diameter of the radial artery are limitations of the transradial approach that may be even more true for distal radial access. The Slender approach aims to address these issues by reducing the size of introducers and devices to minimize trauma to the radial artery and make radial access available to more patients. Despite clear clinical advantages, adoption of Slender PCI has been limited due to cost, operator learning curve, and perceived clinical benefit. Nonetheless, the Slender PCI concept has spurred innovation leading to the development of thin-walled introducer sheaths, which are now widely adopted, and downsized devices compatible with 5 Fr guide catheters to further minimize vessel trauma. These advances in Slender PCI also hold the promise of safer and more accessible radial access procedures for improved patient outcomes.