ObjectiveTo determine whether hemisphere involvement and infarct location on the Alberta Stroke Program CT Score (ASPECTS) template should serve as predictors of 90-day clinical outcome in patients with acute ischemic stroke with pretreatment diffusion-weighted imaging (DWI)–ASPECTS 0–5 treated with mechanical thrombectomy (MT).MethodsWe analyzed data of all consecutive patients included in the Endovascular Treatment in Ischemic Stroke registry between January 1, 2012, and August 31, 2018, who presented with a pretreatment DWI-ASPECTS 0–5 and underwent MT. Multivariable analyses were performed in order to identify the role of infarct location and hemisphere involvement on good outcome defined by a modified Rankin Scale (mRS) score 0–2 at 90 days and on the whole distribution of mRS (shift analysis).ResultsA total of 344 patients with a DWI-ASPECTS 0–5 (median 4, IQR 3–5) were included. Neither infarct location nor hemisphere involvement was found to be an independent predictor of good outcome. Involvement of the M6 region in right-sided strokes (adjusted odds ratio [aOR] 2.6, 99% confidence interval [CI] 1.14–5.8; p = 0.003) and the internal capsule in left-sided strokes (aOR 2.6, 99% CI 0.8–7.9; p < 0.020) independently predicted increased disability on the mRS distribution in the affected subpopulations.ConclusionOur study suggests that neither hemisphere nor infarct location should be considered as an exclusion criterion for MT in patients with stroke with pretreatment DWI-ASPECTS 0–5. The involvement of specific regions of interest was associated with increased disability. These may provide valuable information regarding stroke management options and neurologic recovery for use of caregivers in the postacute phase.