The research analyzed 777 patients with type A acute aortic dissection (ATAAD), of which 121 (15.6%) had malperfusion syndrome (MPS) and were hemodynamically stable without aortic rupture or tamponade. These patients first underwent endovascular reperfusion (aortic or mesenteric branch stenting) followed by delayed open aortic repair. Patients without MPS (656, 84.4%) received immediate open repair. Overall in-hospital mortality in patients with MPS was 37.2%, which is significantly higher than in patients without MPS (8.2%). Patients with MPS who successfully underwent stenting and subsequent delayed repair had a mortality of 11.7%, comparable to patients without MPS (p = 0.306), and similar short-term survival. Independent predictors of mortality associated with irreversible organ failure were hypertension, leukocytosis, fibrin degradation products (FDP), D-dimers, and the FDP/D-dimer ratio. Endovascular stenting of the aorta or its branches is a minimally invasive procedure with short-term patency and favorable short-term results in stable patients.