For the diagnosis and treatment of ischemic stroke, it is likely that telemedicine is a legitimate option to guide treatment decisions, including the administration of tPA, at rural and remote hospitals and results in positive outcomes without compromising patient safety. Telemedicine technologies that allow for image transfer tend to perform better than technologies that do not. The majority of the data included in this review is based on non-randomized patients and non-blinded assessors and thus should be interpreted with caution.