A propensity-matched real-world cohort from the TriNetX network (1,728 pairs, 71 healthcare organizations, 2016 to 2025) found 1-year all-cause mortality of 3.4 percent on GLP-1 receptor agonists versus 9.4 percent off them in adults with asymptomatic intracranial atherosclerotic stenosis. Hazard ratio 0.35. Ischemic stroke ran 4.4 percent vs 6.1 percent (HR 0.70). The matching list included HbA1c, LDL, BMI, and systolic blood pressure. The signal persisted anyway.