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Background: Several studies have suggested that stroke patients with an ASPECT score (ASPECTS) ≥7 benefit from endovascular recanalization.Objective: The purpose of the study was to examine the benefit of endovascular recanalization for stroke patients with low ASPECTS.Materials and Methods: Among 373 consecutive stroke patients treated with endovascular recanalization at our hospital from March 2007 to March 2017, those with ASPECTS ≤6 were included in the study and classified into three groups based on ASPECTS of 6 (APS6), 5 (APS5), and ≤4 (APS4). Preprocedural factors, procedures, and angiographic and clinical outcomes were compared among the three groups.Results: A total of 111 patients were included in the analysis, with 41, 37, and 33 in the APS6, APS5, and APS4 groups, respectively. Median age (74, 76, and 80 years, respectively), median baseline NIHSS (21, 21, and 24), occluded site (ICA-MCA: 14-27, 14-23, and 21-12), intravenous rt-PA (5, 3, and 4), complete recanalization (TICI 2b/3: 34, 25, and 19), and median onset to recanalization time (329, 385, and 360 min) did not differ significantly among the three groups. However, the APS4 group had a lower favorable outcome rate (mRS 0-2 at 3 months: 27%, 16%, and 6%) and higher 3-month mortality (12%, 11%, and 21%).Conclusions: In stoke patients with low ASPECTS, endovascular recanalization is beneficial in those with ASPECTS of 6. Results were equivocal in those with ASPECTS of 4, suggesting a need for caution with the indication for recanalization in these patients.