<p>Telestroke is an innovation in telemedicine in the form of a method for identifying, assessing, treating and monitoring stroke patients remotely using internet technology. Telestroke can speed up the diagnosis and treatment of acute stroke through direct video consultations between doctors and patients separated by distance. The aim of this systematic review is to analyze the implementation of telestroke in improving the clinical outcomes of acute stroke patients in the South-East Asia Region (SEAR). The literature search was carried out through 2 electronic databases, namely PubMed and ScienceDirect which include articles published up to 31 December 2024, and published in English. Before selecting the studies, the study duplication was detected by Zotero Reference Manager^® and then removed. The related studies examined and selected with rayyan.ai^® website using a “blind-on” mode to ensure eligibility. A total of 6 studies were included. We found that there were 3 types of telestroke programs being implemented, namely remote radiology teleconsultation, drip and ship methods, and also international teleconsultation between Thailand and Laos. Telestroke can provide better opportunities and associated with the clinical outcomes of acute stroke patients with faster door-to-treatment and better 3-month outcomes as well, although published data is still limited. It is hoped that telestroke can bridge this gap, allowing hospitals in rural areas to provide care equivalent to hospitals that have stroke specialists especially in SEAR for improving acute stroke services.</p>