OBJECTIVE Postoperative stroke is a serious unsolved complication after acute type A aortic dissection repair. We investigated the incidence and risk factors of stroke and hypothesized that dissection of supra-aortic vessels is an important risk factor of this morbidity. METHODS Between 2012 and 2019, 202 (56% men, median age 68 years) patients with acute type A aortic dissection underwent surgical repair. Clinical data, image findings,　methods of circulatory support, and repair technique were retrospectively investigated to explore the risk factor of postoperative stroke. RESULTS Of 202 patients, operative mortality was 6% and the incidence of postoperative stroke was 12% (n=25). Brachiocephalic artery dissection was associated with a higher risk of stroke (odds ratio, 3.89, 95%CI 1.104-13.780; P= .035) having no relation with the presence or absence of left common carotid artery dissection. Preoperative malperfusion syndrome, circulatory arrest time, isolated cerebral perfusion time, repair technique (total arch replacement), and femoral artery perfusion alone were not related to the incident rate of postoperative stroke. Stroke occurred in both hemispheres, regardless of the laterality of carotid artery dissection. CONCLUSION Brachiocephalic artery dissection was an independent risk factor of stroke after acute type A aortic dissection repair.