This chapter discusses left atrial appendage occlusion for preventing stroke—step-by-step technique and current status. Approximately one-third of all ischemic strokes are caused by cardiac embolism, mostly considered the consequence of atrial fibrillation. These strokes tend to be rather large, as the cardiac emboli are relatively large in size and, therefore, occlude the cerebral arteries more proximally resulting in more severe neurological deficits. This chapter covers the pre-procedural and peri-procedural imaging in left atrial appendage occlusion, trans-septal puncture, devices for left atrial appendage closure, amplatzer cardiac plug/amulet, coherex wavecrest, lariat and medical therapy following left atrial appendage occlusion.