Patient: Description (onset time, main symptoms, hospital visited, etc.): In February 2006, I had a headache and was in a coma for a day and a night, and was diagnosed with cerebral vascular spasm at the county hospital. In May 2011, the condition became more serious, with slight pain in the back of the head, dizziness, general weakness, sweating, chest tightness, and sometimes some aphasia. Later, I went to the hospital for tests: liver, gallbladder, spleen, pancreas, and blood pressure were all normal. The EEG showed that there were problems with the blood vessels in the brain. Then I had an angiographic DSA on the advice of my doctor, and was diagnosed with smog. There were infarcts. During the few days in the hospital, the doctor mainly used mannitol to lower the intracranial pressure and took an anti-platelet drug. Now I have been home for several months, but I feel that my condition has not improved. Do I have to undergo surgery in general? Is it possible to reconstruct the cerebral vessels after surgery? I have uploaded the DSA angiogram. Doctor: The diagnosis of smog is clear, the collateral circulation in the brain has not been fully established, so it is easy to have ischemic infarction symptoms, and it should be helped to establish intracranial and extracranial communicating collateral circulation early. The key depends on the condition of the superficial temporal artery (angiography to see the external carotid artery phase). Waiting for the side branch is too thin and easy to bleed, it will be a little later. I just feel dizzy, weak, and unsteady. Is it possible to reconstruct the cerebral vessels after surgery? Will the surgery affect other neurological functions? I am afraid that my speech and body will be impaired after the surgery because my speech and body are normal now. I have asked the neurologist, and their opinion is that I should not operate until I have to, because I am afraid that the bypass area will continue to get thinner after the surgery. Is that possible? So I’m still in the dark and don’t know what to decide. I don’t know how to decide, but I’m afraid of brain hemorrhage if I wait, and I don’t know how to decide if I don’t. I hope Prof. Sun will help me with some treatment ideas. Doctor: The surgery does not change the original blood vessels in the brain and does not disturb the normal brain tissue, but only reconstructs the blood vessels outside the neck to the surface of the brain, the blood vessels outside the neck do not become thin, and the reconstructed blood vessels will not become thin, so it will be too late to do it after the bleeding. In the natural course of smoker’s disease, the blood vessels in the brain gradually become thinner because the internal carotid artery or middle artery, which is the source of blood supply, is occluded, and there is no blood supply to the distal end, so the distal cortical blood vessels gradually become thinner, not the blood vessels themselves will gradually become thinner, these are two different things. Patient: Thank you, Professor Sun. Can I get your number in the specialist clinic? I’m afraid I won’t be able to get an appointment in Beijing. Doctor: Friday afternoon, ask me directly for an additional number.