Intracranial atherosclerotic stenosis (ICAS) is a primary cause of ischaemic stroke, but it might not be the main predictor of stroke recurrence.A comprehensive assessment of dual antiplatelet therapy (DAPT) effectiveness via the ICAS burden (ICASB) is crucial for patients with minor stroke.This prospective, multicentre cohort study included patients with minor (National Institutes of Health Stroke Scale score ≤ 5) stroke. The ICASB was determined by the degree and number of ICAS occurrences. The primary efficacy outcomes were all stroke types (ischaemic or haemorrhagic). Ninety-day and one-year follow-up evaluations were conducted.Among the 3,061 patients (age=61.7±12.0 years; males, 73.3%), 61.0% (n=1,868) received DAPT, and 39.0% (n=1,193) received single APT (SAPT). Finally, 2,900 and 2,709 patients were included in the 90-day and one-year outcome assessments, respectively. The primary outcome occurred in 242 patients (8.3%) at 90 days and 353 patients (13.0%) at the one-year follow-up. In patients with high ICASBs (but not those with low ICASBs), compared with SAPT, DAPT was associated with a lower recurrent stroke rate at the 90-day (weighted absolute risk difference, 7.3%; IPTW HR==0.58 [95% CI=0.39-0.87]) and one-year (weighted absolute risk difference, 3.9%; IPTWHR==0.68 [95% CI=0.45-1.03]) follow-ups. Significant interactions were observed at the 90-day (Pinteraction=0.021) and one-year (Pinteraction=0.086) follow-ups. Similar results were observed for the propensity score matching model.For minor stroke patients receiving APT, DAPT reduced stroke recurrence at 90 days in the high ICASB group but not in the low ICASB group.Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.