The RETRIAD Study: Comparative First-Pass Reperfusion Performance of EmboTrap III, Trevo NXT, and APERIO Stent Retrievers in Acute Large-Vessel Occlusion Stroke: A Single-Center Retrospective Cohort Study
- 1Department of Neurology, Faculty of Medicine, Niğde Ömer Halisdemir University, Bor Yolu Üzeri, Central Campus, 51240 Niğde, Türkiye
- 2Department of Neurology, Niğde Ömer Halisdemir University Training and Research Hospital, Aşağı Kayabaşı Mahallesi, Hastaneler Caddesi, Kumluca Mevkii, 51100 Niğde, Türkiye
Abstract
Background/Objectives: Contemporary stent retrievers differ in design, yet direct comparative evidence regarding their first-pass reperfusion performance using a standardized endpoint remains limited. This study compared first-pass reperfusion outcomes among APERIO, Trevo NXT, and EmboTrap III. Methods: In this exploratory, single-center retrospective cohort study, 200 patients were screened between 1 March 2024 and 1 August 2026. Forty patients had not completed 90-day follow-up at the time of the initial data analysis. An additional 104 patients were excluded because of tandem occlusion (n = 29), recanalization after intravenous thrombolysis before thrombectomy (n = 8), distal vessel occlusion (n = 30), or successful direct aspiration without stent-retriever deployment (n = 37). The final cohort comprised 56 patients treated with first-line combined stent-retriever and aspiration thrombectomy using APERIO (n = 28), Trevo NXT (n = 14), or EmboTrap III (n = 14). The primary endpoint was strict first-pass effect (FPE), defined as first-pass expanded Treatment in Cerebral Ischemia (eTICI) grade 2c–3. Results: Strict FPE was achieved in 16/28 (57.1%), 9/14 (64.3%), and 9/14 (64.3%) patients, respectively (global exact p = 0.879). Both comparisons with APERIO yielded an absolute risk difference of +7.1 percentage points (95% CI, −23.2 to +33.6). Exploratory adjusted analyses yielded imprecise estimates. Heidelberg-classified symptomatic intracranial hemorrhage occurred in zero, three, and two patients, respectively. Conclusions: No statistically detectable difference in strict FPE was demonstrated among the three device-based treatment strategies. However, the small sample size, wide confidence intervals, and nonrandomized treatment allocation preclude conclusions regarding device equivalence or causal effects.
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BibTeX
@article{akcay2026retriad,
title = {{The RETRIAD Study: Comparative First-Pass Reperfusion Performance of EmboTrap III, Trevo NXT, and APERIO Stent Retrievers in Acute Large-Vessel Occlusion Stroke: A Single-Center Retrospective Cohort Study}},
author = {Halil İbrahim Akçay},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218412},
url = {https://www.mdpi.com/2077-0383/15/21/8412},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The RETRIAD Study: Comparative First-Pass Reperfusion Performance of EmboTrap III, Trevo NXT, and APERIO Stent Retrievers in Acute Large-Vessel Occlusion Stroke: A Single-Center Retrospective Cohort Study
AU - Halil İbrahim Akçay
PY - 2026
DA - 2026/10/29
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218412
UR - https://www.mdpi.com/2077-0383/15/21/8412
AB - Background/Objectives: Contemporary stent retrievers differ in design, yet direct comparative evidence regarding their first-pass reperfusion performance using a standardized endpoint remains limited. This study compared first-pass reperfusion outcomes among APERIO, Trevo NXT, and EmboTrap III. Methods: In this exploratory, single-center retrospective cohort study, 200 patients were screened between 1 March 2024 and 1 August 2026. Forty patients had not completed 90-day follow-up at the time of the initial data analysis. An additional 104 patients were excluded because of tandem occlusion (n = 29), recanalization after intravenous thrombolysis before thrombectomy (n = 8), distal vessel occlusion (n = 30), or successful direct aspiration without stent-retriever deployment (n = 37). The final cohort comprised 56 patients treated with first-line combined stent-retriever and aspiration thrombectomy using APERIO (n = 28), Trevo NXT (n = 14), or EmboTrap III (n = 14). The primary endpoint was strict first-pass effect (FPE), defined as first-pass expanded Treatment in Cerebral Ischemia (eTICI) grade 2c–3. Results: Strict FPE was achieved in 16/28 (57.1%), 9/14 (64.3%), and 9/14 (64.3%) patients, respectively (global exact p = 0.879). Both comparisons with APERIO yielded an absolute risk difference of +7.1 percentage points (95% CI, −23.2 to +33.6). Exploratory adjusted analyses yielded imprecise estimates. Heidelberg-classified symptomatic intracranial hemorrhage occurred in zero, three, and two patients, respectively. Conclusions: No statistically detectable difference in strict FPE was demonstrated among the three device-based treatment strategies. However, the small sample size, wide confidence intervals, and nonrandomized treatment allocation preclude conclusions regarding device equivalence or causal effects.
SN - 2077-0383
ER -