When it comes to the treatment of smog, we must first clarify several questions: is smog a terminal disease, can it be cured, and will it slowly get better on its own if left untreated? To answer these questions it is necessary to understand the stages of smog. Smoke disease is divided into 6 stages Stage I: Stenosis at the bifurcation of the internal carotid artery. DSA only shows stenosis at the end of the internal carotid artery and at the beginning of the anterior and middle cerebral arteries. Stage II: the period of abnormal vascular network formation. large vascular stenosis develops at the base of the brain, smoke vessels are formed, and all major vessels are dilated. Stage III: increased anomalous vascular network: increased and thickened smoky vessels at the base of the brain and poor filling of the anterior and middle cerebral arteries. Stage IV: the anomalous vascular network thinning stage, the smoky vessels become thinner and reduced, and poor filling of the posterior cerebral artery is seen. Stage V: The anomalous vascular network shrinks, the smoke vessels are further reduced, and all cerebral arteries are poorly visualized or not visualized. Stage VI: The anomalous vascular network disappears. The intracranial segment of the internal carotid artery system is completely unremarkable. The cerebral blood system is circulated only from the external strong artery or vertebral artery system. The above 6 stages are the manifestations on the whole brain angiography (DSA). In stages 1 and 2, patients usually have no obvious symptoms, but in stages 3 and 4, patients will show brain hemorrhage or brain infarction, which is a very dangerous period, and many patients die or become disabled as a result. When stage 5 is reached, the cerebrovascular condition is gradually stabilized, and by stage 6, the patient is completely cured. Therefore, it is possible to answer the previous question that smog can be completely cured. Some smog patients will never develop the disease for the rest of their lives, and they can achieve complete self-healing through their own compensations. However, more patients with stage 3 or 4 smog can’t wait for their own slow compensation to enter stage 5 or 6, so we need to make smog patients enter stage 5 or 6 as soon as possible through surgery. In clinical work, many doctors believe that the surgical treatment of smog is not effective, and even the patient’s symptoms are more severe after surgery. Why is this? The answer is that not all patients with smog should undergo surgery, and preoperative evaluation is very important. The preoperative evaluation mainly includes: whole brain angiography (DSA) and CT angiography with perfusion (CTP). Check these 2 key tests. It can be said that going for a smog surgery without these tests is blind, simply put that is taking chances and cannot control the outcome of the surgery. For example, if the patient has established compensation, but the surgery destroys it, then the patient’s symptoms are bound to worsen. These patients should never undergo surgery, and all we can do is administer fluids and adjuvant therapy. After completing the preoperative evaluation, surgery can be performed. There are two types of surgery: direct vascular anastomosis and indirect vascular anastomosis, which are considered to be the most effective treatment, but in clinical work, the risk of this surgery is high, and the results are not as good as those described in books or online. At present, we mainly use indirect vascular anastomosis for treatment, which is less risky, less traumatic and has faster recovery after surgery. From the patient’s six-month follow-up MRA, good vascular changes can be clearly seen.