Distal radial access (DRA) has emerged as an alternative vascular access to conventional transradial access (TRA) for coronary angiography and percutaneous coronary intervention (PCI), paving the way for its use in patients with complex coronary lesions, such as chronic total occlusions, left main disease, heavily calcified coronary lesions, or complex bifurcation lesions. However, current evidence on DRA is mostly limited to patients undergoing diagnostic procedures and PCI of non-complex coronary lesions using ≤6 Fr sheaths or guiding catheters. Available data on the feasibility and safety of DRA for complex PCI are scarce and limited to case reports, case series, small single-center studies, and multicenter registries that have included only a small number of patients treated with large-bore (≥7 Fr) PCI. Overall, these studies have demonstrated the feasibility and safety of DRA for complex PCI, but dedicated randomized trials are needed to confirm these promising results. The ongoing DISCO COMPLEX randomized trial (NCT05490238) will determine the potential superiority of DRA over conventional TRA with respect to forearm radial artery occlusion in patients undergoing complex large-bore PCI using a 7 Fr thin-walled introducer sheath. This chapter aims to provide a comprehensive review of the evidence and future perspectives on DRA in complex coronary interventions.