The timing of surgery for smog is very important, and the best results can only be achieved if the surgery is performed during the stable phase of the disease. In patients with hemorrhagic smoldering disease, which often manifests as intracerebroventricular cast hemorrhage, surgery at this time is mainly for intracerebroventricular blood drainage and is not suitable for intracranial and extracranial revascularization at this time. For patients with hemorrhagic type, intracranial and extracranial vascular bypass is usually chosen to be performed after 3 months of cerebral hemorrhage. For ischemic type, which is often symptomatic of cerebral infarction, vascular bypass is generally performed only after 1 month after infarction; for patients with acute massive cerebral infarction, dural reversal temporalis muscle patching can be performed in the process of emergency debridement and decompression, so the timing of surgery should be carefully selected according to the specific clinical situation and the patient’s symptoms, and the appropriate surgical approach should be taken. Smoker’s disease generally manifests bilaterally, and bilateral surgical treatment is the only way to effectively stop the further development of the patient’s condition and reduce the patient’s risk of reoccurrence of cerebral infarction and cerebral hemorrhage. Otherwise, if only one side is done and not the opposite side, then it is at most half cured.