Objective To construct a perioperative nursing pathway for intracranial arterial stenosis based on symptom management strategy and evaluate its intervention value on cognitive function. Methods A total of 91 patients with intracranial artery stenosis who underwent stent implantation from November 2022 to March 2024 were selected for the study. According to the random number table method, they were divided into the observation group (46 cases, receiving perioperative nursing under symptom management strategy) and the control group (45 cases, receiving perioperative routine nursing). The intervention of the two groups lasted 3 months. The psychological status [Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD)], daily living ability [Activity of Daily Living Scale (ADL)], cognitive function [Montreal Cognitive Assessment Scale (MoCA)] and the incidence of adverse reactions were observed and compared between the two groups before and after the intervention. Results After the intervention, the HAMA scores and HAMD scores of the two groups were lower than those before the intervention, scores of the observation group were lower than those of the control group, and the difference was statistically significant (P<0.05); after the intervention, the ADL scores and MoCA scores of the two groups were higher than those before the intervention, the observation group demonstrated higher scores than the control group, and the difference was statistically significant (P<0.05). The incidence of adverse reactions in the observation group was lower than that in the control group (2.17% vs. 17.78%), and the difference was statistically significant (P<0.05). Conclusion The implementation of perioperative nursing pathway based on symptom management strategy can significantly improve the psychological status, cognitive function, daily living ability and safety of patients with intracranial artery stenosis after stent implantation.