0% to 19% of cerebral infarction cases caused by intracranial arterial stenosis are due to stenosis of the anterior or posterior cerebral arteries. For symptomatic intracranial segmental internal carotid artery, intracranial segmental vertebral artery, basilar artery, and M1 segmental atherosclerotic severe stenosis of middle cerebral artery, the application of arterioplasty can achieve satisfactory results. There are fewer reports in the literature on atherosclerotic stenosis of the anterior cerebral artery, and its long-term outcome is unclear. The angle between the anterior cerebral artery and the internal carotid artery is mostly acute, so in cases of stenosis at the beginning of the anterior cerebral artery, it may be difficult to pass the guidewire and balloon through the stenotic segment, and there is a risk of vascular injury. In this case, the right internal carotid artery is occluded, and the left internal carotid artery is involved in the blood supply to the right hemisphere through the left anterior cerebral artery and anterior communicating artery, so opening the left anterior cerebral artery can significantly improve the blood supply to the right hemisphere. However, the stenotic segment was located at the beginning of the left anterior cerebral artery, so if stenting was performed, the blood flow of the left middle cerebral artery might be affected; in addition, considering the small diameter of the vessel, the restenosis rate after stenting might be high, and it would be difficult to intervene in case of restenosis, so balloon angioplasty alone was used. After the procedure, the patient’s symptoms improved significantly, and 22 follow-up angiograms later showed that the vessel at the lesion was flowing smoothly and no restenosis was observed. The clinical follow-up results and DSA review showed that the long-term outcome of balloon angioplasty of the anterior cerebral artery in this case was satisfactory. Therefore, if there is no significant residual stenosis in the anterior cerebral artery after balloon angioplasty, stenting should not be performed as much as possible, so that it is easier to re-intervene if restenosis occurs.