[From critical evaluation based on the gold standard to precision full-process management: advances in the diagnosis...

Supra-aortic arch artery diseases,including lesions of the carotid,subclavian,and vertebral arteries,represent major causes of cerebral and upper extremity ischemia. The diagnostic and therapeutic strategies for these conditions are undergoing a profound transformation-from conventional open surgery toward minimally invasive endovascular treatment,and further to individualized precision medicine. Recent advances in imaging assessment have substantially improved lesion characterization and risk stratification. The iterative evolution of endovascular devices has enhanced procedural safety. Meanwhile,several topics have become research hotspots,the evidence-based comparison between transcarotid artery revascularization and transfemoral carotid stenting;the renewed pathophysiological understanding of subclavian steal syndrome and vertebral artery diseases;and the construction of individualized treatment decision-making frameworks. Nevertheless,current clinical practice still faces challenges such as controversies over optimal surgical approaches,insufficient prevention and management of complications,and a lack of robust long-term outcome data. From the perspective of vascular surgery,this article systematically reviews recent advances in endovascular devices,surgical techniques,and treatment concepts,aiming to provide front-line clinicians with up-to-date,practical,and actionable insights into the management of supra-aortic arch artery diseases.