Purpose <p>The treatment time window for acute ischemic stroke (AIS) is a key factor in clinical decision-making. However, traditional time window limitations may deprive some patients beyond the time window of the opportunity for effective treatment. Fast Stroke one-stop imaging technology offers new possibilities for individualized treatment. This article was designed to validate the diagnostic potential of Fast Stroke imaging in people within the standard time window and those in the extended time window.</p> Methods <p>A retrospective analysis was conducted on the clinical and imaging data of 106 patients with AIS. Fast Stroke imaging was performed using the GE Revolution 256-slice CT.</p> Results <p>The infarct core volume in the extended time window group (EG) was markedly larger as against the standard time window group (SG) (<i>P =</i> 0.029), but the ischemic penumbra was more extensive (<i>P &lt;</i> 0.001), with a greater proportion of posterior circulation occlusion (<i>P =</i> 0.048) and poorer collateral circulation compensation (<i>P =</i> 0.042). The multimodal combination model had a markedly higher predictive efficacy [area under the curve (AUC) = 0.91] than single parameters (<i>P &lt;</i> 0.05). Although the proportion of endovascular treatment was lower in the EG (<i>P =</i> 0.028), there was no increased risk of hemorrhage (<i>P =</i> 0.765), and the 90-day good prognosis rate in the EG remained lower as against the SG (<i>P =</i> 0.032).</p> Conclusion <p>Fast Stroke one-stop imaging can break through traditional time window limitations and accurately identify salvageable brain tissue, providing a basis for individualized treatment.</p>