Van der Poel, Ganna and Pogacar were among the favourites for victory in the first Monument of the season but a race featuring predictable protagonists thrilled throughout.
A eight-man break went clear in cold and rainy conditions early on before they were caught.
Slovenia’s Pogacar, seeking his first Milan San-Remo title after three consecutive top-five finishes, used his UAE Team Emirates-XRG squad to set up a devastating move on the Cipressa climb before more attacks on the Poggio.
As the riders looked at each other approaching the final straight, Van der Poel made the decisive move, leaving Ineos Grenadiers’ Ganna to finish runner-up to him, as he did in 2023, with Pogacar taking third for the second year in a row.
Only six riders have more Monument victories than Van der Poel and Pogacar, with Gino Bartali, Tom Boonen and Fabian Cancellara also winning seven in their careers.
Van der Poel is also the first multiple champion of this event since Spain’s Oscar Freire, who won the last of his three Milan-San Remo titles in 2010.
Michael Matthews took the bunch sprint behind to finish fourth, with Fred Wright the highest-placed British rider in 10th.
