Stroke is the second leading cause of death and the third greatest cause of disability worldwide. In some countries, stroke disproportionally affects Indigenous Peoples, with greater incidence and mortality at younger ages, higher rates of conventional cardiovascular risk factors and lower treatment rates. Worldwide there are 470 million Indigenous Peoples, residing in 90 countries. Analogous to the general health of all populations, the cause of stroke and its outcomes are the result of complex interactions between factors that act at societal, service, and individual levels. Colonisation, including the cultural and material losses associated with it, is a major indirect driver of disparities in lifestyle, biological and other risk factors for stroke in Indigenous Peoples. In addition, structural racism and the inability to access culturally safe education, employment and health care, further contribute to stroke health inequities for Indigenous Peoples globally. In this narrative review we provide an outline of stroke incidence rates, common risk factors for stroke, treatment rates with intravenous thrombolysis and endovascular clot retrieval in adult Indigenous populations in comparison to the non-Indigenous population of the same region. Our objective is to describe the differences that exist between the Indigenous and non-Indigenous populations with stroke in a particular region and discuss potential solutions that support a “strengths-based” approach driven by Indigenous People.