A systematic review and meta-analysis was performed to evaluate the safety and efficacy of IV alteplase delivered through telestroke networks in patients with AIS. sICH rates were similar between patients subjected to telemedicine- guided IV alteplase and those receiving IV alteplase at stroke centers. There was no difference in mortality or in functional independence at 3 months between telestroke-guided and stroke center managed patients. The findings indicate that IV alteplase delivery through telestroke networks is safe and effective in the 3-hour time window.59 See Table XII in online Data Supplement 1. Telestroke networks may be reasonable for triaging patients with AIS who may be eligible for interfacility transfer in order to be considered for emergency mechanical thrombectomy. IIb B-NR New recommendation. An observational study compared clinical outcomes of EVT between patients with anterior circulation stroke transferred after teleconsultation and those directly admitted to a tertiary stroke center. The study evaluated 151 patients who underwent emergency EVT for anterior circulation stroke. Of these, 48 patients (31.8%) were transferred after teleconsultation, and 103 (68.2%) were admitted primarily through an ED. Transferred patients were younger, received IV alteplase more frequently, had prolonged time from stroke onset to EVT initiation, and tended to have lower rates of symptomatic intracranial hemorrhage and mortality than directly admitted patients. Similar rates of reperfusion and favorable functional outcomes were observed in patients treated by telestroke and those who were directly admitted. Telestroke networks may enable the triage and the delivery of EVT to selected ischemic stroke patients transferred from remote hospitals.60 See Table XII in online Data Supplement 1. Providing alteplase decision-making support via telephone consultation to community physicians is feasible and safe and may be considered when a hospital has access to neither an in-person stroke team nor a telestroke system. IIb C-LD New recommendation. 