We compared the risk of radial artery occlusion (RAO) in patients undergoing coronary intervention with introducer sheath (SG) or without introducer sheath (SLG). 1251 consecutive patients, from 2 tertiary care center in Pennsylvania, USA, undergoing percutaneous coronary interventions (PCI) between 2008–2013 formed the study cohort (SLG: 161 patients, SG: 1090 patients). Radial artery patency was assessed using plethysmography. The association between sheath use and RAO was assessed using unadjusted, adjusted and propensity macthed logistic regression analyses. Mean age: 65 years, men: 63%, diabetics: 37%. SG was associated with lower RAO at band removal [unadjusted (OR: 0.31, 95% CI: 0.21–0.46), adjusted (OR: 0.10, 95% CI: 0.05–0.20) and propensity matched (OR: 0.20, 95% CI: 0.13–0.32)], at 24 hours [unadjusted (OR: 0.20, 95% CI: 0.12–0.34), adjusted (OR: 0.12, 95% CI: 0.06–0.24) and propensity matched (OR: 0.13, 95% CI: 0.07–0.25)] and 30 days [unadjusted (OR: 0.28, 95% CI: 0.14–0.54), adjusted (OR: 0.22, 95% CI: 0.10–0.50) and propensity matched (OR: 0.18, 95% CI: 0.10–0.40)], compared to SLG. Sheath use during radial access for PCI is associated with less RAO. It is unclear if use of introducer sheath during radial access for PCI reduces incidence of RAO. In this prospective cohort study involving 1251 concecutive patients undergoing PCI via radial access between 2008–2013, we assessed the difference in incidence of RAO between the SG (n = 1090) and the SLG (n = 161 patients) groups. SG group experienced lower incidence of RAO at band removal, 24 hours and 30 days post PCI in the unadjusted, adjusted, and propensity matched analyses compared to the SLG group. In conclusion sheath use during radial access for PCI is associated with less RAO.