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The establishment of stroke networks is an approach to forward guideline driven stroke care to hospitals without full-time neurological service. Tele- stroke networks are evidence based for remote neurological support of acute stroke patients, administration of thrombolysis safely as well as increasing thrombolysis rates. Since 2011 the district hospital in Grabs was linked to the stroke center at the cantonal hospital St. Gallen which provided teleconsultations with full-scale audiovisual communication and access to brain images 24 hours per day 7 days per week. Regarding quality and safety issues the experiences were promising including the selection of patients for appropriate treatment with allocation to systemic thrombolysis or en dovascular reperfusion therapy. As perspective it may definitely contribute to better supply of rural areas with acute stroke therapy but also other specializations and neurological indications may benefit from telemedical support