Disclosed herein are methods and devices for small-vessel access to the vasculature for vascular and cardiac procedures such as diagnostics and interventions, particularly methods and devices for radial, brachial, popliteal, pedal, carotid and/or axillary access to the vasculature. These methods and devices permit vascular and cardiac procedures to be carried out through small vessels, such as the radial or brachial arteries, with a reduced number of steps for the physician and reduced pain and trauma for the patient. As such, the devices and methods may improve a number of outcomes for the patient, such as by reducing the risk of bleeding complications and increasing the speed with which the patient resumes ambulation and other activities following the procedure.