See Table XCV in online Data Supplement 1 for original wording. Studies of teleradiology to read brain imaging in acute stroke have successfully assessed feasibility; agreement between telestroke neurologists, radiologists, and neuroradiologists over the presence or absence of radiological contraindications to IV alteplase; and reliability of telestroke radiological evaluations. Further support for this unchanged recommendation from the 2013 AIS Guidelines with LOE upgraded to A is provided by 3 additional studies published since the 2013 Guidelines.55 57 See Table X in online Data Supplement 1. The use of telemedicine/telestroke resources and systems should be supported by healthcare institutions, governments, payers, and vendors as one method to ensure adequate 24/7 coverage and care of acute stroke patients in a variety of settings. I C-EO Recommendation reworded for clarity from 2013 Stroke Systems of Care. COR and LOE added to conform with ACC/AHA 2015 Recommendation Classification System. See Table XCV in online Data Supplement 1 for original wording. Telestroke/teleradiology evaluations of AIS patients can be effective for correct IV alteplase eligibility decision making. IIa B-R New recommendation. The STRokEDOC (Stroke Team Remote Evaluation Using a Digital Observation Camera) pooled analysis supported the hypothesis that telemedicine consultations, which included teleradiology, compared with telephone-only resulted in statistically significantly more accurate IV alteplase eligibility decision-making for patients exhibiting symptoms and signs of an acute stroke syndrome in EDs.58 See Table XI in online Data Supplement 1. 1.5. Hospital Stroke Teams (Continued) COR LOE New, Revised, or Unchanged Powers et al 2019 Guidelines for Management of AIS e353 Administration of IV alteplase guided by telestroke consultation for patients with AIS can be beneficial. IIa B-NR New recommendation. 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. 