In January 2007, a telestroke system was established between a community hospital lacking a neurologist on call and a stroke centre 70 km away. The telestroke system allowed urgent remote evaluation of the patient by a specialized neurologist, supervised thrombolytic treatment or a decision for urgent transfer to the stroke centre. During the first year of operation of the telestroke system, we studied all acute ischaemic stroke patients admitted to the community hospital and compared the results with the previous year. Approximately the same number of acute stroke patients were admitted to the community hospital in each year (201 cases in 2006 and 198 in 2007). The telestroke system was activated 75 times in 2007, the number of stroke patients evaluated by a specialized neurologist increased (17% vs. 38%, P > 0.001) and interhospital transfers were reduced (17% vs. 6%, P = 0.001). The number of thrombolytic treatments was doubled: 4.5% (n = 9) in 2006 vs. 9.6% (n = 19, 12 of them in the community hospital) in 2007 (P = 0.073). The telestroke system also reduced the time to tPA treatment from symptom onset (210 vs. 162 min, P = 0.05) and increased the number of patients treated in the 0-3 hours window (40% vs. 63%, P = 0.09). Telemedicine improved the quality of care administered to acute stroke patients admitted to a community hospital and reduced the number of inter-hospital transfers.