Smoker’s disease is a cerebrovascular disease characterized by chronic progressive stenosis or occlusion of the internal carotid arteries bilaterally, and secondary to the formation of an abnormal vascular network at the base of the skull. This abnormal network of vessels at the base of the skull resembles “smoke” on cerebral angiography and is called “smoky vessels”. There are two peak incidences of the disease, around the age of 5-9 years and around the age of 45-49 years, respectively. There are more female patients than male patients. In children, ischemic symptoms are the main clinical manifestation, while in adults, hemorrhagic symptoms are often the main manifestation. Nearly half of adult patients can develop intracranial hemorrhage, which can often cause severe neurological impairment, and patients are also at risk for recurrent bleeding. Patients presenting with spontaneous cerebral hemorrhage, especially intraventricular hemorrhage; clinical signs and symptoms due to recurrent transient cerebral ischemia in children or young patients should be considered for the disease. The mortality rate of smoldering disease is about 7.5%, and the main cause of death is intracranial hemorrhage. Cerebral angiography is the gold standard for the diagnosis of smog. There are no effective drugs to reduce the rate of hemorrhage in patients with smog. Surgical treatment of smog is significantly more effective than pharmacological treatment, and the vast majority of patients with smog are currently treated surgically. Smog has a progressive nature, so surgery should be performed once the diagnosis is clear. Surgery can be divided into direct and indirect revascularization surgery. Revascularization surgery can effectively improve the hemodynamic impairment and reduce the incidence of ischemic stroke in patients.