The runtime pseudo relocations can't handle the AArch64 format PC relative addressing in adrp+add/ldr pairs. By using stubs, the potentially dllimported addresses can be touched up by the runtime pseudo relocation framework.
The MachineOperand TargetFlags range (8 bits) is just about exhausted; this allocates the last bit to MO_COFFSTUB. (In the X86 target, the TargetFlags are just direct values, while most of it is used as a bitfield on ARM and AArch64.) An alternative, to conserve bits, would be to use MO_GOT (which doesn't have much meaning in a COFF context right now).
Currently in the AArch64 target, the MO_GOT flag is set for any indirect access (so we have MO_GOT | MO_DLLIMPORT or MO_GOT | MO_COFFSTUB).