Brachiocephalic takayasu arteritis (BCTA) is the most common type of TA, which involves the branch vessels of the aortic arch. In severe cases, severe cerebral ischemia symptoms are observed, and the patient’s activity tolerance is severely reduced, and he cannot even take care of himself, which seriously affects the patient’s quality of life. This type of TA is difficult to treat and has a high complication rate, making it the most difficult type of TA to treat. Epidemiology: This disease is common in Japan, India, Korea, China and other Asian countries, rare in Europe and the United States. The incidence of the disease is common in young and middle-aged women, and the literature reports that the ratio of male to female incidence is 1:3.1~8.3, and the age of onset is 20-30 years old, with male incidence being later than that of female. The pathogenesis is unknown. Head and arm type is the most common type of TA, and the incidence of BCTA in Japan is higher than that of other types. In China, the literature reports that the proportion of head and arm type TA is between 48.4% and 54.5%, which is the most common type of TA. Among BCTA patients, 56.3% to 60% involved the left subclavian artery, 39.3% to 40% involved the left common carotid artery, and 6.5% to 19% involved the innominate artery. 2. Natural course: Ishikawa et al. found that the survival rate at 15 years after TA diagnosis was 82.9% in 120 patients with a median of 13 years of natural course, and that the major complications included retinopathy, hypertension, aortic regurgitation, and aneurysm. Multifactorial analysis of the follow-up data resulted in major complications, progression and increased sedimentation rate as independent factors affecting prognosis. Survival rates were 66.3% and 96.4% for patients with and without major complications, respectively, and for those who progressed versus those who did not: 67.9% and 92.9%. The prognosis of patients with different ages also differed, with survival rates of 58.3% and 92.7% for those aged >35 years and <35 years, respectively. With the advancement of interventional materials and surgical techniques, the proportion of BCTA patients undergoing balloon dilatation or open surgery has been increasing recently. Early diagnosis of the disease, aggressive pharmacologic and combined surgical treatments have improved the prognosis of patients. A grading system was established based on these three factors: those with major complications and in the progressive stage are stage III, with a 15-year survival rate of only 43%; those with no clinical manifestations have the best prognosis for stage I, with no deaths in any of the patients. Conservative treatment with drugs is recommended for stage I and II patients, while stage III patients should be treated with active drug therapy and surgery, which can increase the long-term survival rate of stage III patients. Diagnostic criteria and means: At present, the American College of Rheumatology (ACR) put forward the diagnostic criteria of TA in 1990: (1) age of onset <40 years old; (2) intermittent claudication of limbs; (3) weakening of the brachial artery pulsation; (4) difference in systolic blood pressure of the upper limbs of the two limbs >10mmHg (1mmHg=0.133kpa); (5) vascular murmur; (6) arterial angiographic abnormalities. In 1996, Sharma et al. proposed a modified diagnostic criteria for TA, including 3 major criteria (left and right subclavian artery lesions and characteristic signs and symptoms lasting at least 1 month) and 10 minor criteria (increased sedimentation rate, carotid artery tenderness, hypertension, aortic regurgitation, pulmonary artery disease, left common carotid artery disease, distal cephalic and brachial arteries disease, descending aortic lesion, abdominal aortic lesion). lesions, abdominal aortic lesions, and coronary artery involvement) with a sensitivity of 92.5% and a specificity of up to 95%. On the basis of the above diagnosis, BCTA can be diagnosed as long as the vessels involved are mainly unnamed arteries, common carotid arteries, and other cranial vessels, as evidenced by angiography or CTA. Clinically, patients with unexplained headache, fever, and increased inflammatory markers, especially young women, should be considered as possible candidates for BCTA. Laboratory tests show increased sedimentation rate (ESR), positive C-reactive protein (CRP), increased serum electrophoresis of α and γ globulin and decreased albumin, positive serum anti-aortic antibodies in about 91.5% of patients, and lesions in the fundus of the eye in some patients, with aphakic ophthalmopathy as a specific manifestation of the disease. Imaging to determine vascular lesions is important for the diagnosis and further treatment of TA. In the diagnosis of BCTA, attention should also be paid to differentiate from giant cell arteritis and arteriosclerotic disease. 4. Assessment of disease activity: Once BCTA is diagnosed, it is important to assess its activity and severity. At present, it is more commonly used is the indicator of disease activity proposed by Kerr et al. The following two or more newly appeared or aggravated clinical manifestations indicate disease activity: (1) systemic symptoms: fever, skeletal and muscular symptoms; (2) increased blood sedimentation; (3) vascular ischemia or inflammation characteristics: intermittent claudication, pulse weakening or pulselessness, vascular murmur, vascular pain, and asymmetry of blood pressure, etc.; (4) angiographic Abnormalities. 5, drug therapy: drug therapy is still the main treatment of BCTA, applicable to the early stage of the disease, active patients and with surgical treatment. 6. Timing and choice of surgery: Surgery can improve the prognosis of patients with severe disease. At present, there are mainly 2 types of surgical treatment: interventional therapy and open surgery.