Background: Current guidewires for transradial coronary angiography had defects of passage difficulty or branch injury. This study sought to investigate the safety and efficiency of a novel method of active knuckle angle 0.035-inch hydrophilic guidewire in transradial coronary angiography.Methods: Patients who underwent a transradial coronary procedure from August 2015 to June 2020 were consecutively noted. Of them, 1457 patients were allocated into the Traditional group, while the following

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... 2 patients were allocated into the Knuckle group to investigate the safety. In addition, 239 patients were randomly divided to evaluate its efficiency. Results: Unwilling passage of guidewire into branches occurred more in Traditional group than in Knuckle group (9.5% vs. 0.08%, p<0.001). Of them, 2 patients experienced guidewire associated perforation in Traditional group. Covered stent was used for 1 patient with internal mammarian artery perforation, and the other was treated with compression for brachial branch perforation. Furthermore, duration of guidewire advancement from the sheath to aortic root significantly decreased in the Knuckle group (22.6±8.0s vs. 33.4±16.9s, p<0.001). Conclusions: Active knuckle angle guidewire was a novel method to prevent unwilling passage and associated perforation, which also improved the efficiency and reduced radiation exposure.