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

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.