With the development of science and technology and the continuous progress of interventional equipment, internal carotid artery stenting has become increasingly popular among patients in view of its advantages, which include high efficiency, minimally invasive, and fast postoperative recovery. It has grown importance as a surgical method for the treatment of severe internal carotid artery stenosis. This paper discusses a rare case of severe internal carotid artery stenosis and its management, where various types of pre-dilatation balloons were not able to be positioned in the stenting process. Relevant solutions have also been proposed in hope to provide a more theoretical and practical basis for clinical work.