Coronary artery bypass grafting (CABG) is the gold standard for the treatment of left main disease, whereas percutaneous coronary intervention is a viable option for patients who are candidates for revascularization but ineligible for CABG. CABG is limited by extended hospital stay followed by rehabilitation and mediocre long-term patency of saphenous vein grafts. Drug-eluting stents decrease the restenosis rates compared with bare metal stents and provide comparable clinical outcomes with those of CABG. Patients with isolated left main disease limited to the ostium or midbody are most likely to have good clinical outcomes with low restenosis and stent thrombosis rates. The results of the ongoing EXCEL trial, which compares left main percutaneous coronary intervention with drug-eluting stents and CABG, will provide insight regarding the ideal revascularization strategy for these patients.