The lumen of the radial artery in many patients is smaller than the outer diameter of a 6 Fr radial sheath frequently leading to procedural pain, trauma to the radial artery, and contributing to radial occlusion. Chronically, neointima formation further reduces luminal size, limiting successful re-intervention in some patients. Sheathless guides are 1-2 Fr sizes smaller than corresponding sheaths and potentially may reduce radial artery trauma. Although it is not currently recommended for routine use, the 6.5 Fr EauCath Sheathless guide (Asahi Intecc) has a lower profile than a 5 Fr sheath, the same inner lumen as a 6 Fr guide, and has been shown to be useful especially for interventional procedures requiring 6 Fr techniques in patients with small radial arteries. Similarly, the 7.5 Fr EauCath (Asahi Intecc) has a lower profile than a 6 Fr sheath, the same inner lumen as a 7 Fr guide, and is useful for procedures requiring a large bore guide catheter. Alternatives include the MediKit Works 5 Fr sheathless system and long dilators designed to allow the sheathless introduction of conventional guides. The recently approved ‘Flip’ dilator (Vascular Solutions, Inc.) is now available outside Japan, but experience is currently limited.