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Background: The Lone Star Stroke Consortium TeleStroke Registry (LESTER) currently consisting of 3 academic hub centers and 25 partner spokes is a statewide initiative organized by UTHealth to understand practice patterns of acute stroke management via telemedicine (TM) in Texas, a state with one of the largest rural populations in the US.Methods: All presumed stroke patients for whom a TM consultation has been obtained in the network are entered into a web-based, HIPAA-compliant database from 9/2013 to 3/2016. 90-day mRS and disposition are obtained by a standard phone interview.Results: A total of 3390 TM consults were performed: 57.3% acute ischemic stroke (AIS); 8.6% TIA; 1.4% ICH; 32.3% non-stroke related diagnoses (Table). Half of the cases were < 65 years of age. Overall 38.3% of AIS cases received tPA and 12.5% of all cases were transferred to a hub. tPA rates varied from 19% to 50% and transfer rates varied from 0% to 37.5% among spokes with at least 10 AIS consults.Conclusions: In this statewide registry of telestroke organized by academic health centers, TM leads to substantially high rates of tPA administration for AIS cases compared with national treatment rates in the US. TM provided by academic centers also leads to low rates of transfer from spoke hospitals, suggesting improvement in allocation of healthcare resources.