Stroke is the third largest cause of death after cardiovascular disease and cancer in industrial countries and a major factor in permanent disability. Acute stroke care requires rapid assessment, including patients ‘medical history and accurate diagnostics: “time is brain”. The putative advantages of telemedicine are improvements in the quality of stroke care and increased use of tPA, which is associated with better health outcomes. The objective of this report is to assess the feasibility, acceptability, and treatment delivery reliability of telemedicine systems in acute stroke management. A secondary aim is to explore the feasibility and acceptability of telerehabilitation interventions in stroke management.

Telestroke interventions can bring therapeutic benefits, which are currently mainly available in specialized stroke centers. Telemedicine associations were associated with an increased delivery of systemic tPA, which improved patients’ health outcomes. Economic studies on telemedicine interventions in stroke management are lacking. Studies of higher methodological quality are needed to explore the potential cost-effectiveness of telemedicine technologies in stroke management. It is difficult to draw conclusions from the small sample of telerehabilitation studies included in this report. The few identified articles show promising results in terms of improving stroke patients’ and/or caregivers’ well-being. More research is necessary to determine the impact of telerehabilitation services. Several programs have been identified as being at the forefront of telestroke. The lack of standardized measuring and reporting of resources and health outcomes constrain comparisons between telestroke networks and the determination of best practices. More research is needed to accurately measure the clinical and economic impact of telemedicine technologies in stroke management to support policy makers in making informed decisions. Quality indicators for evaluation of telestroke projects are proposed.