Left main angioplasty is considered a very high-risk procedure and consequently, surgical treatment remains the first choice for left main critical disease. Recently, the advent of new devices such as directional atherectomy, rotablator atherectomy and stent implantation have modified this point of view. In fact, in selected groups of patients for whom CABG is not suitable, left main percutaneous angioplasty can be performed with stent implantation, yielding good final results with a residual stenosis less than 20-30% and a long-term survival comparable to surgery. In conclusion, in some selected cases left main angioplasty, also if unprotected, can be performed safely with satisfactory results.