A new surgical procedure for smog, a disease in which the shape of the cerebral blood vessels on cerebral angiography is like the curl of smoke coming out of a chimney during an attack, has given rise to the name smog. Since the disease was first discovered in Japan more than half a century ago, the international medical community has been exploring ways to treat this rare disease, and research has never stopped. It has been developed until now, and there has been a great progress and improvement. The results of the initial exploration are broadly divided into two categories, direct bypass surgery and indirect bypass surgery. Direct bypass surgery is to improve the blood supply to the brain by connecting the blood vessels outside the skull directly to the blood vessels on the surface of the brain, while indirect bypass surgery is to improve the blood supply to the brain by affixing blood vessels with regenerative ability, periosteum, and tendon membrane to the surface of the brain, but based on the current clinical results, both of these surgical approaches are inadequate and cannot allow all patients with smog to be effectively treated. How is smog treated now? What are the new surgical options for smog? Combined vascular bypass surgery is now recognized worldwide as the most appropriate procedure for the treatment of smog, and is a combination of both indirect and direct revascularization. The direct bypass improves blood flow immediately and prevents short-term cerebral infarction, while the indirect patching procedure allows smog patients to grow more capillaries on the back surface of the brain, expanding the scope of blood supply improvement. This new surgical procedure was introduced in Japan by experts, and after continuous clinical observation, practice and application in China, nearly 1,000 cases of smog patients have been treated, all with excellent results.