Abstract: Introduction: among patients with ischemic stroke (IS), more than 17% has atrial fibrillation (AF). The active application of aspiration thrombectomy (AT), in addition to thrombolytic therapy (TLT), can significantly improve functional outcome, prognosis and survival of patients with IS. The main method of preventing of IS in patients with nonvalvular AF today is still an anticoagulant therapy, but percutaneous transcatheter occlusion of the left atrium appendage (LAA) can be an alternative method, especially if anticoagulant therapy is contraindicated or ineffective. Aim: was to demonstrate results of a complex staged treatment of an age-related patient with nonvalvular atrial fibrillation, complicated by the development of cardioembolic ischemic stroke while taking anticoagulants. Material and methods: a clinical observation of a 81-year-old patient delivered to the hospital with a clinical manifestation of ischemic stroke in the “therapeutic window”, with a history of persistent AF and taking anticoagulants, is presented. After conservative therapy - a regression of neurological symptoms was achieved. Three days after - negative dynamics in the clinical picture with development of aphasia and right-sided hemiplegia. Multispiral computed tomography with contrast (MSCT-A): occlusion of M2 segment of the left middle cerebral artery (MCA). Patient underwent aspiration thrombectomy with complete restoration of blood flow and regression of neurological symptoms. After 2 months from the episode of IS, patient underwent implantation of occlude in the left atrial appendage as a prophylaxis of re-embolism, followed by the abolition of warfarin. Results: a senile patient returned to normal life and self-care (assessed using the modified Rankin scale 1). During next 13 months patient had no major adverse cardiac events (MACE) or significant bleeding and all that shows that occlusion of LAA is effective. Conclusions: in the early period of ischemic stroke, isolated aspiration thrombectomy is the operation of choice in patients with atrial fibrillation and contraindication for thrombolytic therapy, and endovascular occlusion of the left atrial appendage can be the method of choice for secondary prevention of ischemic stroke. Further studies are required to assess applicability and reproducibility of the approach we have described in routine clinical practice. References 1. Hankey G.J. Stroke. The Lancet. 2017; 389 (10069): 641-654. https://doi.org/10.1016/S0140-6736(16)30962-X 2. Feigin V.L., Krishnamurthi R.V., Parmar P., et al; GBD Writing Group; GBD 2013 Stroke Panel Experts Group. Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study. 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