Smoke disease, also known as spontaneous basilar artery ring occlusion, is a disease characterized by a slow thickening of the intima at the end of the internal carotid artery and the beginning of the anterior and middle cerebral arteries, a gradual narrowing of the arterial lumen to the point of occlusion, and a compensatory dilation of the penetrating arteries at the base of the brain. The shape of the dilated vessels on imaging resembles the curl of smoke in a chimney, which is why the Japanese call it smoke disease. Smoky disease was first discovered by the Japanese. Since 1962, when the first non-Japanese case of smog was reported in Subirana, smog has been reported from all over the world, but mainly in the yellow race. The highest incidence is in Japan, followed by South Korea and China and other Southeast Asian regions. There are two peaks in the age of onset: childhood at about 4 years of age and middle age at 30-40 years of age. The ratio of childhood to adult incidence is 5:2. The etiology of smoky disease is not well understood. The prevalence is 42 times higher among siblings and 37 times higher in children of patients. Recently, it has been found that smog may be genetically related. The main pathological change of smog disease is the proliferation of elastic fibers in the intima of the internal carotid artery, which gradually narrows the lumen of the internal carotid artery and eventually occludes it. The endothelial lesions usually occur at the end of the internal carotid artery, the beginning of the anterior and middle cerebral arteries, and occasionally spread to the main trunk of the anterior and middle cerebral arteries and the external carotid artery, as well as to other parts of the body. In order to compensate for the reduced cerebral blood flow due to the thickening of the intima of these intracranial blood supply arteries and the narrowing of the lumen, the small vessels at the base and surface of the brain compensate for the reduced cerebral blood flow, resulting in the formation of smoldering vessels. When the rate of compensatory vasodilation to increase cerebral blood flow is less than the rate of reduction of cerebral blood flow due to the narrowing of cerebral blood supply arteries, cerebral ischemic symptoms arise and cerebral infarction and cerebral atrophy appear. Brain softening, etc. The clinical manifestations of smoker’s disease are divided into 6 types from mild to severe. The milder ones have the onset of transient transient cerebral ischemia (TIA), manifested as headache, epilepsy, limb weakness, sensory abnormalities and visual field changes, while the severe ones have a life-threatening onset of cerebral infarction or cerebral hemorrhage. The diagnosis of smog disease is mainly based on DSA and MRA imaging, and can refer to the diagnostic criteria for smog disease and smog phenomenon established by the Japanese Ministry of Health and Welfare in 1995: 1. Angiographic features: (1) Stenosis or occlusion of the end of the internal carotid artery or the beginning segment of the anterior and middle cerebral arteries on one or both sides. (2) Anomalous smoky vascular network at the base of the skull is seen in the arterial phase of angiography. (1) Stenosis or occlusion of the end of the internal carotid artery and the beginning of the anterior and middle cerebral arteries can be seen on MRA. (2) Anomalous vascular network in the basal ganglia can be seen on MRA (more than two flow voids in the basal ganglia on MRI can also be diagnosed as anomalous vascular network). 3. Etiological features: unknown etiology and exclusion of other underlying diseases (such as arteriosclerosis, meningitis, tumor, trauma, radiotherapy, Down syndrome, VonReclinghausen’s disease). 4. Pathological structural features (alternative vascular imaging changes in autopsy cases): (1) Endothelial thickening of the internal carotid artery leading to luminal narrowing or occlusion, usually bilateral changes with lipid deposition. (2) The main arteries forming the base arterial ring (anterior, middle and posterior communicating arteries) have varying degrees of luminal stenosis or occlusion due to intimal thickening. (3) Many small penetrating arteries and anastomotic branches are seen around the base arterial ring. (4) Tiny vessels accumulate in the soft meninges to form a network. The treatment of smoldering disease is not yet very satisfactory in China. Internal medicine treats symptomatically with vasodilators as well as antimicrobials, but the efficacy is not satisfactory. Most scholars use the indirect anastomosis method invented by Japanese scholar Mr. Yoshiharu Matsushima in 1979, that is, the extracranial vessels are led across the skull and dural barrier into the skull to promote blood supply to the cerebral cortex, and the method has few complications. Since the late 1970s, under the guidance of the famous neurosurgeon Prof. Duan Guosheng, the author has treated more than 1000 cases of smog using intracranial and extracranial vascular fusion and direct anastomosis of intracranial and extracranial vessels. At the same time, the author also combined the morbidity characteristics of smog patients in China, and further improved the surgical treatment of smog disease, so that some more complicated cases can obtain satisfactory results.