Left main coronary artery disease is the most concerning lesion for coronary intervention. These obstructions pose the greatest risk to the patient, and successful treatment by surgical or interventional means provides the best opportunity to improve survival. However, a complication during intervention resulting in worsening of the obstruction can be acutely disastrous, and restenosis puts the patient back into a chronic risk state. Therefore, getting it right with left main intervention is critical. To complicate matters, left main lesions are usually also bifurcation lesions and are frequently heavily calcified. What is the best way to treat them if an interventional approach is chosen, and which tools give the best result?