When is the best time to have surgery for smoker’s disease? The timing of surgery for smoker’s disease is very important, and the best results can only be achieved if the surgery is performed during the stable phase of the disease. Smog is generally divided into the hemorrhagic type and one type of brain infarction caused by ischemia. In patients with hemorrhagic smoldering disease, they often show intracerebroventricular cast hemorrhage, and the surgery at this time is mainly for intracerebroventricular blood drainage, which is not suitable for intracranial and extracranial blood flow reconstruction at this time. For patients with the hemorrhagic type, intracranial and extracranial vascular bypass is usually chosen to be performed after 3 months of cerebral hemorrhage. For ischemic type, which is often symptomatic of cerebral infarction, vascular bypass is generally performed only after 1 month after infarction; for patients with acute massive cerebral infarction, dural reversal temporalis muscle patching can be performed in the process of emergency debridement and decompression, so the timing of surgery should be carefully selected according to the specific clinical situation and the patient’s symptoms, and the appropriate surgical approach should be taken. Smoker’s disease generally manifests bilaterally, and bilateral surgical treatment is the only way to effectively stop the further development of the patient’s condition and reduce the patient’s risk of reoccurrence of cerebral infarction and cerebral hemorrhage. Otherwise, if only one side is done, not the opposite side, it is at most half cured. Medications used for the treatment of smog are vasodilators, antiplatelet drugs and anticoagulants, etc. These drugs have certain clinical efficacy, but none of the effectiveness has been confirmed by clinical trials. For patients with ischemic symptoms, drugs such as aspirin or Bolivar can be considered, and antiepileptic drugs can be given to patients with epilepsy. There are no effective medications to reduce the rate of bleeding in patients with smog. Surgery is the main treatment for smoldering smoke syndrome and can be effective in preventing and treating ischemic strokes. Surgical treatment of smog is divided into direct bypass surgery, indirect bypass surgery and combined vascular bypass surgery. Direct bypass surgery refers to re-establishing new blood flow channels to ensure adequate cerebral blood flow, by directly bypassing the intracranial and extracranial vessels to anastomose and rapidly improve cerebral blood supply. Indirect bypass surgery involves attaching muscle and meningeal tissues, which are rich in extracranial blood supply, to the surface of the brain inside the skull, so it is also called patching surgery. The brain automatically draws blood vessels from these tissues to form spontaneous anastomoses with the cortical vessels. The blood supply to the brain is reconstructed through extracranial blood flow to the intracranial area to relieve the inadequate supply of blood to the intracerebral arteries, and to improve the intracerebral blood flow by establishing a pathway for blood supply from normal vessels outside the brain to the intracerebral area. After the blood supply to the brain is improved, the demand for smoke-like vessels will gradually decrease, thus reducing the patient’s risk of reoccurring cerebral ischemia and cerebral hemorrhage and improving the patient’s prognosis. Combined vascular bypass surgery is based on the advantages and disadvantages of the two traditional procedures, bypass + patching in one surgery, based on the bypass and multi-factor patching, the establishment of multiple blood flow pathways, can provide abundant blood to the patient’s brain tissue, which can have the advantages of the patching surgery (larger blood supply to the brain) and give the new blood vessels the time needed to grow (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.