There are differences of opinion about what should be recommended for treatment of patients with left main stenosis. That is not surprising because that lesion was for so many years in the domain of the surgeons. Since pivotal trials including EXCEL and NOBLE, and the acceptance of percutaneous coronary intervention (PCI) for left main lesions in the guidelines, the decision about evidence-based left main intervention has become more nuanced. A discriminator in the revascularization guidelines is left ventricular function. Surgery is the preferred approach to left main lesions with reduced ejection fraction in the guidelines, but in practice, this is often balanced against co-morbidities that might elevate the surgical risk. The type of left main lesion also enters the decision pathway. Bifurcation lesions are the most common and sometimes most difficult for PCI, although providing no challenge for surgery. Why do some operators shy away from bifurcation lesions? Why is there so much discussion about what strategy should be employed for the intervention? Should it be a planned single stent with a provisional second stent or a double stenting strategy? If so, which technique – double kissing crush, culotte, T-stenting, or some modification of these? What are the concerns in stenting left main bifurcation lesions? Is it the chance of failure or of complications that could be fatal with little chance to get to emergency surgery? Should a left ventricular assist device be placed prophylactically? All these questions are worth pondering, but I suspect there is no true answer; at least, I would never have put these questions on a high-stakes exam such as the ABIM Cardiovascular Intervention Boards.