Smoker’s disease is a chronic cerebrovascular occlusive disease characterized by severe stenosis or occlusion of the siphon of the internal carotid artery and the beginning of the anterior and middle cerebral arteries bilaterally detected by cerebral angiography, and compensatory proliferation of small vessels such as soft meninges and penetrating arteries at the base of the skull, forming an abnormal vascular network at the base of the brain. It is also a very dangerous disease that can be life-threatening in severe cases. Patients with this disease rarely have increased blood pressure, usually no fever, often in the form of stroke, can appear cerebral ischemia or cerebral hemorrhage, cerebral infarction three groups of symptoms, divided as follows: 1, ischemic group The age of onset is relatively young, the average age of 18.4 years, mostly seen in children and adolescents. The onset is mostly acute, but there are also subacute cases. The symptoms of cerebral thrombosis include dizziness, headache, numbness of limbs, paralysis, mental discomfort and slurred speech. Pseudobulbar palsy, mental disorder, mental retardation or dementia may occur in those with multiple lesions, and about 40% of patients have seizures. 2. Hemorrhagic group The age of onset is mostly later than the ischemic group, with an average age of onset of 33.1 years, with more young adults. Blood pressure is mostly normal. The onset of hemorrhage is sudden, and the common sites of hemorrhage are subarachnoid hemorrhage, primary ventricular hemorrhage and lobar hemorrhage. Therefore, the intracranial hemorrhage caused by smog is mostly a hemorrhage with no obvious physical signs. It often starts with headache, nausea and vomiting, and some patients may have varying degrees of impaired consciousness. The clinical symptoms and signs are the same as those of other causes of intracranial hemorrhage, and the prognosis seems to be better. Smog causes more primary ventricular hemorrhage, and is the main cause of primary ventricular hemorrhage. The blood around the ventricle is supplied by a group of blood vessels distributed away from the ventricle, consisting of the terminal branches of the anterior and posterior choroidal arteries extending from the ventricular surface toward the brain parenchyma, and another group of terminal arteries distributed through the brain parenchyma toward the ventricle. Both groups of vessels are terminal branches that essentially do not anastomose, i.e., constitute the marginal zone. At the same time, these peripheral branches are the farthest from the heart and are fine arteries that proliferate and compensate after the lesion of the main vessels of Willis artery ring, so they are prone to ischemic softening of the ventricular wall and infarct hemorrhage. 3, cerebral infarction Once cerebral infarction occurs, it will lead to different degrees of ischemic necrosis of brain tissues and loss of function in different brain functional areas, thus triggering aphasia, confusion, unresponsiveness, and even hemiplegia in patients. If a patient with smog disease has already developed this condition, to prevent the infarct focus from expanding and causing serious consequences, it can be treated by combined vascular bypass surgery. It can effectively prevent the occurrence of cerebral hemorrhage. Treatment methods and principles of smog disease: The clinical treatment of smog disease includes direct bypass surgery, indirect bypass surgery and combined vascular bypass surgery. Direct bypass surgery refers to the re-establishment of new blood channels to ensure adequate cerebral blood flow, and to rapidly improve cerebral blood supply by directly bypassing the intracranial and extracranial vessels to anastomose. Indirect bypass surgery, or patching surgery, is the application of muscle and meningeal tissue rich in extracranial blood supply to the surface of the brain inside the skull. To relieve the inadequate blood supply to the intracerebral arteries, the blood flow in the brain is improved by establishing a channel for blood supply from normal blood vessels outside the brain to the brain, and the improved blood supply reduces the need for smoke-like vessels, thus reducing the patient’s risk of reoccurring cerebral ischemia and cerebral hemorrhage. Combined vascular bypass surgery is based on the summary of the advantages and disadvantages of the two traditional procedures, bypass + patching in one operation, on the basis of bypass multi-factor patching, the establishment of multiple blood flow pathways, can provide rich blood for the patient’s brain tissue, this can have the advantages of patching surgery (the brain blood supply range is larger) and give the time needed for the growth of new blood vessels (by the direct bypass vessels to maintain normal blood supply). This avoids the development of a stroke before the neovascularization occurs. This is superior to direct bypass and indirect bypass alone. It is clear that the best surgical treatment for smog is a combined bypass procedure that takes the best of both worlds. The surgery has a higher cure rate and less risk. Patients are advised to learn more and communicate with their doctors when choosing the surgery. A skilled physician will be better able to manipulate the direction of the surgery and avoid unnecessary surgical risks.