Background: Transradial access (TRA) for percutaneous coronary procedures has become a widely adopted approach, with proven safety and feasibility. However, the transulnar approach remains a promising alternative. This study aimed to compare radial and ulnar approach for percutaneous coronary procedures as regard feasibility, safety, and incidence of complications. Methods: This prospective comparative study was conducted at the Cardiology Department Cath lab of Benha University Hospitals & National Heart Institute. One hundred patients were included, with 50 patients in the TRA group and 50 patients in the ulnar access (TUA) group. Inclusion and exclusion criteria were defined. Various clinical and procedural parameters, including access techniques, were meticulously recorded. The study assessed immediate post-procedure complications and utilized Doppler evaluations. Results: The study revealed no statistically significant differences between the radial and TUA groups in terms of patient demographics, procedural success, duration, fluoroscopy time, and procedure type. There were also no significant disparities in the affected vessel and the number of deployed stents. However, there was a statistically significant increase in the percentage of spasm in patients with TRA (24%) compared to TUA (8%). Conversely, patients with TUA experienced a statistically significant increase in hematoma (18%) compared to TRA (4%). Conclusions: The transulnar approach for percutaneous coronary procedures showed comparable feasibility and safety to the transradial approach, with specific differences in complications. TUA was associated with a higher incidence of hematoma, while TRA had a higher incidence of spasm.