Background: Symptomatic intracranial artery stenosis (ICAS) poses a substantial public health challenge and economic burden globally. Effective management of ICAS in elderly athletes, who may have unique physiological responses due to their physical conditioning, requires optimized treatment strategies. This study evaluates the efficacy and safety of using lower doses of aspirin combined with clopidogrel as dual antiplatelet therapy (DAPT) for treating symptomatic ICAS in this population. Methods: This investigation included 142 elderly athletes, aged 60 to 81, diagnosed with symptomatic ICAS and enrolled from April 2013 to April 2018. Participants were divided into two groups: the low-dose group (73 patients) received 75 mg of aspirin and 50 mg of clopidogrel daily, while the usual-dose group (69 patients) received 100 mg of aspirin and 75 mg of clopidogrel daily. Results: During the follow-up period, the low-dose group demonstrated a significantly lower recurrence risk of ischemic stroke (IS) and transient ischemic attack (TIA) at both 1-year and 2-year intervals compared to the usual-dose group. Additionally, this group experienced fewer adverse events and instances of gastrointestinal injury. Notably, patients with severe symptomatic ICAS showed a higher recurrence risk than those with mild symptoms, irrespective of the dose regimen. Conclusion: Low-dose aspirin combined with clopidogrel appears to be a safer and more effective regimen for elderly athletes suffering from symptomatic ICAS, particularly in reducing the risk of recurrent IS and TIA over a 24-month period. However, further research with larger sample sizes is necessary to validate these findings, potentially influencing treatment protocols in this specialized population