Background: Telestroke can improve ischemic stroke patient outcomes by improving access to physicians specialized in stroke care and increasing the rate of thrombolysis. The aim of this study to assess the effect of the newly implemented Telestroke service on ischemic stroke patient outcomes in New Brunswick, Canada, a province with a high rural population. Methods: By means of a retrospective chart review, data for 366 adult acute ischemic stroke patients (Telestroke = 15.3%; non-Telestroke = 84.7%) were collected from emergency departmentsspanning five sites in the province. Outcomes included home discharge rates, complications (i.e., hemorrhage,angioedema), mortality, rate of thrombolysis and time to treatment. Results: No significant differences emerged for home discharge rates, complications, mortality or door-to-needle time. Telestroke patients had a significantly greater rate of thrombolysis treatment (51.8% vs 6.1%) and significantly less door-to-CT time (M= 27.63 min vs M= 100.78 min) compared to the non-Telestroke group. Conclusions: Overall, both groups had similar outcomes with some trends toward improvements for patients utilizing Telestroke.