Background Transradial coronary procedure (TRP) traumatizes the radial artery (RA), especially resulting in changes to arterial wall morphology. This study explored the significance of the early onset of traumatic effects to wall layers of the RA following the first TRP (FTRP) and repeat TRP (RTRP) using very-high-frequency ultrabiomicroscopy (VHFUBM). Methods A total of 1431 patients that received TRP were divided into the FTRP group that comprised 781 patients and the RTRP group that comprised 650 patients depending on the number of procedures. Two-dimensional RA images were acquired by 30-55 MHz ultrasound one day before and one day after the procedure. Results After TRP, the incidence of intimal tears, medial dissections and external elastic lamina fracture were greater in the RTRP (P < 0.001). The RTRP group showed significantly thicker intimal thickness (IT), media thickness (MT), adventitia thickness and all complex layer thicknesses as compared with the FTRP group (P < 0.001). Conclusions Multivariate linear regression analysis discovered that repeated TRP and other observations were independent predictors of increased IT in post-operative RA. VHFUBM provides an approach to study structural and histopathological injury in the wall layers of RA which showed increased trauma to the RA following RTRP.