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Introduction Delayed cerebral ischemia (DCI) remains a significant cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (aSAH). Despite identification of numerous clinical and radiographic predictors of DCI, risk remains variable even among patients with similar hemorrhage severity suggesting presence of unrecognized modifiers. One factor receiving little attention is intracranial arterial disease (ICAD): stenosis and calcification. We aim to examine their additive impacts to known modifiers.Methods We retrospectively analyzed 526 adult patients with aneurysmal subarachnoid hemorrhage treated at a single, tertiary care center between 2015-2025. DCI was defined as new neurologic deficits and/or new cerebral infarction ≥ 48 hours from hemorrhage not explained by other etiologies (seizures, re-bleed, thrombotic or embolic complications, etc.). Stenosis (≥25% of luminal diameter) and calcification (CTA hyperdensity ≥ 100 HU) were assessed in all arteries including and distal to the petrous ICA on admission CTA. Multivariable logistic regressions were used to determine independent associations with DCI. For easy clinical applicability, ICAD was dichotomized as presence vs. absence.Results Among 526 patients with aSAH, 440 survived ≥48 hours and were included in this analysis (median age=56 IQR [45-64], 63.7% female). 132/440 (30.1%) developed DCI. DCI was associated with significantly worse outcomes at discharge and follow up (median mRS DCI: 4, No DCI 2, p<0.001). Stenosis, not calcification, was an independent predictor of DCI (aOR:3.556, 95%CI: 1.90-6.65, p<0.001). Vasospasm significantly correlated with DCI (OR:5.89, 95%CI: 3.62-9.57, p<0.001), and was significantly more common in patients with stenosis (aOR:2.391 95%CI: 1.240-4.608, p<0.001). Calcification showed modest protective effect against vasospasm (OR:0.634, 95%CI: 0.406-0.990, p=0.044).Conclusion Pre-existing ICAD confers substantial, independent DCI risk after aSAH, enhancing rather than competing with traditional predictors. This suggests that baseline cerebrovascular integrity meaningfully predicts ischemic vulnerability following hemorrhage. Incorporating intracranial stenosis into early DCI risk stratification is simple and may significantly guide prognostication and intensified monitoring, improving outcomes following aSAH.Disclosures R. Moseley: None. A. Helal: None. M. Salem: None. Y. Zhou: None. H. Granberg: None. Z. Folzenlogen: None. C. Roark: None. J. Seinfeld: None.