Back in 1987, a pioneer experience of angioplasty performed on unprotected left main coronary artery lesions was reported. Results of this early evaluation were not encouraging, describing a procedural mortality of 4.3% in elective patients and 3-year survival of only 36% in the unprotected subgroup [1]. These data led to abandoned attempts to revascularize percutaneously with balloon angioplasty lesions involving the left main coronary artery.The availability of stents prompted a resurgence of percutaneous left main interventions (PCI). Several authors reported encouraging results following stenting of unprotected left main lesions in selected patients. Angiographic restenosis has been found to occur in 22% of the patients [2] with a 3-year mortality as low as 3.8% in a selected subgroup [3]. Experienced operators reported favorable results even in lesion subsets such as bifurctional left main stenosis (a restenosis rate of 14% in the parent vessel [4]), traditionally considered not particularly suitable for PCI.Despite these encouraging results, the risk related to the occurrence of restenosis, potentially presenting as sudden death, is still a limiting factor to the implementation of PCI on unprotected left main stenosis [5]. The availability of drug-eluting stents may abolish this concern [6], but we need to wait for appropriate studies.While awaiting confirmatory data, the main area of application of most left main interventions are in the emergency setting. Stenting has been performed with good outcome in the setting of acute myocardial infarction [7][8][9][10] to treat complications occurring during coronary arteriography [11,12] or during intravascular ultrasound evaluation (IVUS) [13]. Since its availability, stenting gained the premier role over balloon angioplasty in the setting of emergency left main PCIs. This statement is supported by a subanalysis of multicenter registry on unprotected left main interventions. When the authors analyzed the emergency procedure part of the Unprotected Left Main Trunk Intervention Multicenter Assessment (Ultima) experience, the 12-month rate of death or bypass surgery was 83% and 58% for the PTCA and the stent groups, respectively (P ϭ 0.047) [14].The case reported in this issue [15] reflects the value of stenting to resolve most of the complications occurring in the cardiac catheterization laboratory. The unique features of this case are that the angiographic complication (overt left main dissection) was not associated with sign or symptoms suggestive of ischemia, and the problem occurred in a hospital where no coronary interventions or cardiac surgery was available.The operators took a conservative approach: they observed for 30 min that the clinical conditions remained stable before moving the patient from the cardiac catheterization suite and then for an additional 7 days prior to consider an intervention. Following this period of time, during which the patient remained stable, a decision was taken to transfer the patient to an institution performing PCI. Focal st...