Despite a growing interest in academic spin-offs (ASOs), research has overlooked the determinants, strategies, and outcomes of their internationalization choices. In this chapter, we review existing literature on the topic of internationalization of ASOs, connecting it to international business and international entrepreneurship literature, identifying relevant theoretical and empirical knowledge gaps. We then carry out a descriptive investigation about the characteristics and internationalization patterns of ASOs in the Italian context, drawing on a survey on 120 companies. Based on the review and our results, we highlight research areas deserving future investigation.