Smoker’s disease is a chronic cerebrovascular occlusive disease characterized by severe stenosis or occlusion of the siphon of the internal carotid artery and the beginning of the anterior and middle cerebral arteries bilaterally on cerebral angiography, and compensatory proliferation of small vessels such as soft meninges and penetrating arteries at the base of the skull, forming an abnormal vascular network at the base of the brain. It is called smoky disease because in angiography, the shape of the abnormal blood vessels at the base of the brain resembles the smoke exhaled during smoking. Smoke disease is a rare disease. Pediatric patients have better ability to perform daily living and survival, and most patients do not cause significant impairment in daily activities while undergoing benign treatment. Adult patients may have poor ability to perform daily living and survival due to intracranial hemorrhage. How can smog be detected? After explaining a lot of professional words, you should also see the clouds, the following is to explain some easy to understand. To be on the safe side, what tests should be done to determine the presence of smog? Digital subtraction angiography (DSA) is the gold standard for diagnosing smog. Patients with clinical and imaging manifestations of suspected smog should undergo DSA as soon as possible, as DSA not only accurately shows the location and degree of stenosis of the diseased vessels, but also shows the compensatory pathways of the collateral circulation. In a word, whether you want to check whether you have smog or have some clinical symptoms and are worried about smog, you should have a digital subtraction angiography. In order to detect and treat smog early, patients should undergo surgery as soon as possible, as conservative treatment is not really effective. What is the treatment for smog? There are currently three surgical treatments for smog. The first is direct revascularization, which can directly improve the blood supply to the brain tissue and reduce the risk of perioperative stroke, with significant results in the near future. In the second approach, indirect revascularization, a portion of the tinged tissue containing the branches of the external carotid artery (dura, temporalis, capitulum, or STA) is removed and placed directly on the surface of the ischemic brain tissue, where the neovascularization is stimulated by angiogenic factors secreted by the ischemic brain parenchyma, which in turn generates new collateral circulation to supply blood to the affected area. However, it takes at least three months for effective neovascularization to develop, and the effect is slow and better in pediatric patients than in adult patients. The third type is combined vascular bypass surgery. We all know that smog requires surgery, but which surgery should be chosen for treatment, and since we are worried about which treatment should be chosen, let’s hear what the experts have to say. Combined vascular bypass surgery is the most effective treatment for smog. The treatment of smog is complex, and the medical community is always exploring it. At present, combined vascular bypass surgery is a relatively advanced surgery for the treatment of smog, combined vascular bypass surgery integrated with the traditional direct bypass + patching, is a composite surgery, through the direct bypass quickly establish blood flow side branch channel, improve the local blood supply to the brain. At the same time, indirect bypass is performed through multi-factor patching to induce the formation of neovascularization in a larger area and improve the cerebral blood supply on a larger scale. The two procedures are done on the same table, which shortens the operation time and ensures the safety of the operation, and the efficiency of the operation is also improved. The surgical establishment of blood collateral circulation channels to improve the cerebral blood supply deficiency is very direct and effective.