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The purpose of this review was to present our current clinical protocol utilizing selective antegrade cerebral perfusion during aortic arch surgery and to compare it to other published experience. Clinical Protocol: Since 2013, our clinical protocol for aortic arch surgery has evolved to using selective antegrade cerebral perfusion via the innominate artery, moderate hypothermia, and ancillary strategies such as goal-directed perfusion (GDP). Other published techniques favored antegrade cerebral perfusion but were limited by smaller cannulae, multiple cannulation sites, and lower cooling temperatures. Conclusion: Our clinical protocol may offer higher flow rates, avoid complications associated with additional cannulae, and provide an easy setup for dual arterial perfusion. 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