Objective: To explore the feasibility of remote intravenous thrombolysis guidance based on WeChat platform in patients with acute cerebral infarction. Methods: From January 2017 to January 2019, 26 acute cerebral infarction patients treated with remote intravenous thrombolysis guidance based on WeChat platform in 3 primary hospitals (Jindong District Traditional Chinese Medical Hospital of Jinhua City, Zhejiang Province; Wucheng District People′s Hospital of Jinhua City, Zhejiang Province; Hospital of China Water Resources and Hydropower Bureau No.12 Company Limited) were selected as observation group, and 28 acute cerebral infarction patients treated with intravenous thrombolysis who transferred to Jinhua Hospital of Traditional Chinese Medical, Affiliated to Zhejiang Chinese Medicine University by these 3 primary hospitals were selected as control group. The onset-to-door time (ODT), onset-to-needle time (ONT) and door-to-needle time (DNT) were recorded; National Institutes of Health Stroke scale (NIHSS) was recorded before treatment and 7 d after treatment; 90 d after treatment, the prognosis was evaluated by modified Randkin scale (mRS); the safety was evaluated by the incidence of intracerebral hemorrhage within 24 h and the mortality of 90 d after treatment. Results: The ODT and ONT in observation group were significantly shorter than those in control group: (67.88 ± 20.57) min vs. (100.57 ± 20.11) min and (131.46 ± 27.76) min vs. (151.32 ± 31.51) min, the DNT was significantly longer than that in control group: (63.58 ± 15.49) min vs. (50.75 ± 13.17) min, and there were statistical differences (P<0.01 or <0.05); there was no statistical differences in NIHSS score before treatment and 7 d after treatment between 2 groups (P>0.05); there were no statistical difference in the incidences of intracerebral hemorrhage and mortality between 2 groups (P>0.05). Ninety days after treatment, the rate of good prognosis in observation group was better than that in control group: 69.2% (18/26) vs. 39.3% (11/28), and there was statistical difference (P<0.05). Conclusions Remote guidance intravenous thrombolysis based on WeChat platform in patients with acute cerebral infarction can improve the thrombolysis rate, shorten ONT and significantly improve the long-term prognosis. But compared with that of advanced stroke centers, the thrombolysis process of primary hospital needs to be optimized.