Based on the engineering problem of large deformation and support failure in the roadway of Ronghua No. 1 Mine, on-site in situ stress testing was carried out to understand the distribution characteristics of the in situ stress around the roadway. Then, a stability analysis of the roadway was conducted on the key factors causing support failure. Combining the on-site situation and the results of the stability analysis, the principle of surrounding rock stability control in a high horizontal stress roadway was proposed. Based on this principle, an optimized scheme was designed. The optimized scheme and the original scheme were comparatively analyzed through numerical simulation to verify the applicability of the optimized scheme. Finally, the optimized scheme was applied on-site, and the roadway was monitored. The results were as follows: (1) from the results of the in situ stress test conducted in Ronghua No. 1 mine, the horizontal tectonic stress field is dominant. (2) Based on the characteristics of in situ stress distribution, the angle between the direction of the maximum horizontal principal stress and the roadway orientation, along with varying lateral pressure coefficients, is directly proportional to the stress and deformation of the surrounding rock. (3) Through numerical simulation analysis, an optimized support scheme was proposed based on the original design. The roof subsidence was reduced by 37.3%, the floor heave was reduced by 49.5%, and the side convergence was reduced by 34.7%. The surrounding rock stability of the roadway was significantly improved. (4) The optimized support scheme was applied in the 6A# Left Second roadway at Ronghua No. 1 Mine. Through on-site monitoring of the perimeter rock deformation, significant reductions in deformation and increased stability were observed. The research content provides a theoretical basis and practical experience for the stabilization of high horizontal stress roadways.