Coronary artery bypass grafting has long been considered the standard revascularization treatment for unprotected left main trunk disease (ULMTD). Percutaneous coronary intervention (PCI) with bare metal stent (BMS) was performed on patients for whom coronary artery bypass grafting was a high risk or those selected by lesion anatomy such as large simple ostial or body lesion. However, its clinical indication is limited by the high rate of target lesion revascularization (TLR). PCI with drug-eluting stent (DES) is increasingly being performed because of its lower TLR rate. Randomized and meta-analysis studies demonstrate that PCI with DES for ULMTD, compared with BMS, could be more strongly associated with a significant reduction in the need for TLR without any additional adverse outcomes, although it has some limitations on indications.