This single-center retrospective study evaluated the impact of different arterial cannulation strategies on surgical outcomes for patients with acute type A aortic dissection (AD) and intramural hematoma (IMH). By comparing 32 patients who underwent antegrade cannulation with 114 patients who underwent retrograde cannulation, the study found significant differences in total surgical time and intensive care unit stay duration. However, no significant differences were observed in 30-day mortality or postoperative cerebrovascular accident rates. The findings suggest that the choice of cannulation strategy should be tailored to individual patient needs.