Left main disease represents one of the most complex lesion subsets for percutaneous coronary intervention, associated with an increased risk of serious late complications. The recent endorsement of intracoronary imaging for the guidance of left main bifurcation percutaneous coronary intervention in both acute and chronic coronary syndrome, with respective recommendations in American and European guidelines, reflects the results of recent studies. Patient benefit can only be realized through the interventional community embracing the need for intracoronary imaging-guided planning, guidance and optimization of left main stenting. This clinical consensus statement summarizes the views of a global expert panel, coordinated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), in collaboration with the European Bifurcation Club (EBC). The document includes an appraisal of the most contemporary evidence and provides clinical guidance on how to maximize the benefit of intravascular ultrasound or optical coherence tomography in the treatment of left main bifurcation disease.