Medication is unlikely to improve this mechanical stenosis, so the patient currently continues to experience dizziness and weakness in both lower extremities. Ultrasound showed carotid plaque but did not report arterial luminal stenosis, suggesting little problem in the carotid system. The subclavian artery plaque with increased flow velocity suggests arterial stenosis and has clearly reported blood theft, so intervention is necessary. The presence of plaque and fast flow rate does not interfere with the angiography. I recommend direct imaging because it will clarify important information such as whether stenting is needed, whether stenting can be performed, what type and size of stent is needed, how difficult the procedure is, and how risky it is, while CTA will not provide definitive answers to any of these questions; CTA is only used as a preliminary screening test for cerebral stenosis. I think the patient already needs stenting treatment at this point, so there is no need to do CTA. Otherwise, even if a CTA is done, an imaging test is still definitely needed. There are many causes of atherosclerosis, hypertension, hyperlipidemia, diabetes, etc. are only one of the risk factors, and there are no less than 20 risk factors in total. The most important is genetic factors, which account for 70% of the weight, and diet, life, etc., which only account for 30% of the weight. So it’s no surprise that vegetarians suffer from arterial stenosis. This is the reason why many people do not take the control of risk factors seriously, they see with their own eyes that many vegetarians are sick, while many people who smoke and drink seem to be quite “healthy”. This is exactly what evidence-based medicine is currently advocating. —- Large-scale statistics are the most convincing, but they are based on the overall population, and there may be exceptions for individuals, but this does not affect the scientific validity of the overall conclusions. If there are angina-like symptoms, further investigations are needed and there may be problems with the heart. However, it is also possible that the patient is mentally overburdened by considering the stent issue. Weather will not affect the procedure. If the arterial stenosis and blood theft were not severe, conservative treatment might be effective, but at the moment it is the patient’s symptoms that are persisting! I think the problem is now very good to do is to do an imaging to clarify the degree of stenosis, if greater than 70% stenosis, must stent treatment. If it is less than 70%, conservative treatment can be continued. If we don’t do the imaging now, once the current narrowed artery becomes occluded, there is a risk of severe neurological symptoms and probably sequelae that will not fully recover as before. Moreover, if the artery becomes occluded, it will need to be opened, and the opening surgery will be more difficult and risky. My overall feeling is that the patient is now at a stage that is ideal for interventional patients, and the family should not miss the best opportunity for treatment due to excessive worry!