Influence of the Alberta Stroke Program Early CT Score (ASPECTS) and onset-to-recanalization time on clinical outcomes based on the hypoperfusion intensity ratio (HIR). (A) Although the ASPECTS was not significantly associated with a favorable outcome in the low HIR group (p = 0.178), it was an independent factor for a favorable outcome in the high HIR group (p = 0.012). (B) For patients with a high HIR, the chances of a favorable outcome sharply decrease when the onset-to-recanalization time is relatively short. (C) Considering both the HIR and ASPECTS, patients with a low HIR (<0.54) and small core (ASPECTS ≥ 8) have the best clinical outcome in all ranges of onset-to-recanalization time (p < 0.05). In contrast, patients with a high HIR (≥ 0.54) and large core (ASPECTS < 8) have the worst outcome in all ranges of onset-to-recanalization time. Patients with a high HIR and small core have a more favorable outcome than those with a low HIR and large core when onset-to-recanalization time is relatively short. However, for patients with a high HIR and small core, the chance of a favorable outcome decreases more drastically with the course of time and then finally reverses from a particular point of onset-to-recanalization time.