Potent and selective A3 adenosine receptor (AR) agonists were identified by replacement of 4′-oxo- or 4′-thionucleosides with bioisosteric selenium. Unlike previous agonists, 4′-seleno analogues preferred a glycosidic syn conformation and a South sugar puckering, as shown in the X-ray crystal structure of 5′-N-methylcarbamoyl derivative 3p. Among compounds tested, N6-3-iodobenzyl analogue 3d was found to be the most potent A3AR full agonist (Ki = 0.57 nM), which was ≥ 800- and 1900-fold selective for A1 and A2AARs, respectively. In the N6-cycloalkyl series, 2-Cl analogues generally exhibited better hA3AR affinity than 2-H analogues, while 2-H > 2-Cl in the N6-3-halobenzyl series. The N7-isomers 3t and 3u were much weaker in binding than corresponding N9-isomers, but compound 3t lacked A3AR activation, appearing to be a weak antagonist. 2-Cl-N6-3-iodobenzyl analogue 3p inhibited chemoattractant-induced migration of microglia/monocytes without inducing cell death at ≤ 50 μM. This suggests the potential for the development of 4′-selenonucleoside A3AR agonists as novel anti-stroke agents.