A 76-year-old man with acute aortic dissection of Stanford type A underwent aortic arch replacement using retrograde cerebral perfusion for 105 minutes. By the preoperative IADSA an entry was detected in the distal arch. There were no neurological complications. But the postoperative IADSA showed that the surgically closed entry was another one from that diagnosed before operation. This case shows us efficacy of retrograde cerebral perfusion which allows more time for arch repair than the technique of deep hypothermia with circulatory arrest and importance of careful and precise evaluation by preoperative image diagnosis.