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Background This study aimed to investigate the heterogeneity of topographic and connectomic mechanisms underlying diverse functional outcomes in patients with acute ischaemic stroke.Methods and results In 7891 patients from the Third China National Stroke Registry, arterial territory maps, structural disconnection (SDC) maps and functional disconnection (FDC) maps were generated based on their ischaemic lesions. Strategic brain components, associated with functional outcomes, assessed using the modified Rankin Scale scores, were identified using multiperturbation Shapley value analysis. Exploratory subgroup analysis revealed that the strategic components identified in the arterial territory maps and the FDC maps varied by sex and age, but remained consistent in the SDC maps.Conclusion Specific topographic distributions and disconnections associated with adverse functional outcomes were identified, revealing individual heterogeneity related to age and sex. These findings may serve as imaging biomarkers and help generate testable hypotheses for potential neuromodulation targets.