Spontaneous recanalization of a chronically occluded internal carotid artery (ICA) is a rare occurrence. The authors report 3 patients who had documented total occlusion of the ICA followed by late spontaneous recanalization with subsequent high-grade stenosis. The patients in this series had occlusions for 11 months, 36 months, and 39 months, respectively. One patient had symptoms ipsilateral to the recanalized vessel, and 2 patients were asymptomatic. Endarterectomy was performed uneventfully in 2 patients and pathologic specimens demonstrated typical atherosclerotic plaque with patent lumens. Our experience demonstrates that although chronic recanalizations of occluded ICAs are rare, this does occur. Pathology demonstrates typical atherosclerotic plaque which appeared to have been recanalized by lysis of thrombus. The natural history of this condition is not well known and indications for intervention are not well established.
Background
In the absence of guidance from clinicians identifying patients who have the greatest potential to improve function as a benefit of skilled therapy, and writing orders to assure adequate therapy minutes, rehabilitation for the most vulnerable might not have been possible without objective assessment tools. The Frailty Index (FI) is one objective metric for identifying rehabilitation potential. The aim of this study was to evaluate the use of routinely collected data and predictive analytics of FI related to function to estimate rehabilitative potential.
Methods
Retrospective analysis of patients admitted into a large urban skilled nursing facility (SNF) in Western New York for post-acute rehabilitation over a nine-month period (N = 341). Using data collected in the Minimum Data Set (MDS), the change in the GG function scores from admission to discharge (GG AvD/C) was computed for each patient. The study utilized a multiple regression modeling approach to evaluate the variation of the GG AvD/C score across the different categories of frailty.
Results
The results of this analysis suggest that by observing a patient's FI near time of admission, the clinician can make a recommendation, based on an objective metric, when ordering patient treatment frequencies and time, based on the patient’s potential for functional gains.
Conclusions
Using a FI to categorize patients into Frailty Risk Groups provides an opportunity to predict the amount of functional improvement from start of care to discharge as measured using MDS GG functional scores.
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