Political Parties and Political Foundations in Italy. Their Changing Landscape of Structure and Financing

This book, published with research funds from the University of Rome La Sapienza, aims at disseminating knowledge about the Italian system of political parties and political foundations among non-Italian scholars, in the light of the recent legislative reforms in this field. Due to their nature as free associations of citizens under art. 49 Cost., political parties are supposed to enjoy a full autonomy in determining their own purposes, internal organisation and financial management. However, the recent regulation on the funding of political parties contains provisions aimed at influencing the contents of party statutes, imposing upon them several organisational obligations. Moreover, some draft laws concerning the internalfunding have been proposed, with the idea of making intra-party democracy not only a prerequisite for obtaining funds, but also for competing in elections. However, many argue that a law should be the least invasive possible, and parties should instead proceed to self-reformation. The stronger the erosion process of party organisations and of political cultures is, the more strongly affirmed will be the personalised models of political organisation, in which even the funding of the organisation’s own public viability is managed autonomously. This is why ever more frequently some political leaders make use of think tanks for fund-raising, by virtue of the broad degree of autonomy that they enjoy

Treatment of Coronary Atherosclerotic Lesions with Bioresorbable Vascular Scaffolds

The present thesis represents a journey through our initial experience with the bioresorbable scaffold up to the implementation of this technology in complex scenarios such as unstable patients with acute thrombotic lesions, calcified plaques, coronary bifurcations, and even complex chronic total occlusions thus resembling as much as possible the entire spectrum of our daily clinical practice

Immediate versus staged revascularisation of non-culprit arteries in patients with acute coronary syndrome: a systematic review and meta-analysis

Although there is robust evidence that revascularisation of non-culprit vessels should be pursued in patients presenting with an acute coronary syndrome (ACS) and multivessel coronary artery disease (MVD), the optimal timing of complete revascularisation remains disputed. In this systematic review and meta-analysis our results suggest that outcomes are comparable for immediate and staged complete revascularisation in patients with ACS and MVD. However, evidence from randomised controlled trials remains scarce and cautious interpretation of these results is recommended. More non-biased evidence is necessary to aid future decision making on the optimal timing of complete revascularisation

Management of Septal Branch Perforation and Septal Hematoma During Retrograde Treatment of Coronary Chronic Total Occlusion Using Fat Embolization

Septal vessel perforation followed by septal hematoma is a rare complication of retrograde approach for treatment of coronary chronic total occlusions, possibly leading to septal rupture. We report 2 cases of patients with septal vessel perforation and subsequent hematoma successfully treated with autologous fat embolization. Such technique is inexpensive, omnipresent, and relatively easy to perform.L’hematome septal qui suit la perforation septale est une complication rare de l’approche par voie retrograde dans le traitement des occlu- sions totales chroniques d’une artère coronaire qui peut mener à la rupture septale. Nous rapportons deux cas de patients ayant subi une perforation septale et un hematome subs equent qui ont et e trait es efficacement par embolisation par graisse autologue. Cette technique est peu coûteuse, omnipresente et relativement facile à r ealiser

Current approaches for treatment of coronary chronic occlusions

Introduction: Coronary chronic total occlusions (CTO) represent a challenging subset in interventional cardiology. Areas covered: During the last decade, improvements in materials, techniques, and meticulous pre-procedural lesion assessment have increased the success rate in CTO lesions. Several scores have been developed to address overall lesion evaluation and help select the most appropriate treatment strategy. In addition, specific algorithms such as the hybrid algorithm have been introduced to provide a framework for CTO operators and a rapid management of the various challenging aspects of the procedure. The hybrid approach requires opera

Predictors of long-term adverse events after Absorb bioresorbable vascular scaffold implantation: a 1,933-patient pooled analysis from international registries

Aims: The aim of this study was to investigate the predictors of long-term adverse clinical events after implantation of the everolimus-eluting Absorb bioresorbable vascular scaffold (BVS). Methods and results: We pooled patient-level databases derived from the large-scale ABSORB EXTEND study and five high-volume international centres. Between November 2011 and November 2015, 1,933 patients underwent PCI with a total of 2,372 Absorb BVS implanted. The median age was 61.0 (IQR 53.0 to 68.6) years, 24% had diabetes, and 68.2% presented with stable coronary artery disease. At a median follow-up of 616 days, MACE occurred in 93 (4.9%) patients, all-cause death in 36 (1.9%) patients, myocardial infarction in 47 (2.5%) patients, and target vessel revascularisation in 72 (3.8%) patients. Definite or probable scaffold thrombosis occurred in 26 (1.3%) patients. On multivariable logistic regression analysis, acute coronary syndromes (hazard ratio [HR] 2.79, 95% confidence interval [CI]: 1.47 to 5.29; p=0.002), dyslipidaemia (HR 1.43, 95% CI: 1.23 to 1.79; p=0.007), scaffold/reference diameter ratio >1.25 (HR 1.49, 95% CI: 1.18 to 1.88; p=0.001), and residual stenosis >15% (HR 1.67, 95% CI: 1.34 to 2.07; p<0.001) were independent predictors of MACE, whereas the use of intravascular imaging was independently associated with a reduction in MACE (HR 0.13, 95% CI: 0.06 to 0.28; p<0.001). Conclusions: Optimal Absorb BVS implantation and the use of intravascular imaging guidance are associated with lower rates of adverse events at long-term follow-up

Comparison of plaque prolapse in consecutive patients treated with Xience V and Taxus Liberte stents

The purpose of this article is to investigate the prevalence of plaque prolapse (PP) after Xience V and Taxus Liberte stent implantation. During the study period 2006-2007, 200 consecutive patients underwent coronary revascularization for de novo lesions and received an intravascular ultrasound (IVUS) post-stenting evaluation, (n = 124 patients with Taxus Liberte and n = 76 with Xience V) (227 stent segments). Cross-sectional and longitudinal 3D IVUS images were analyzed in a blind fashion, evaluating the prevalence of PP and calculating its depth and angle. The angulation degree of the coronary artery at the lesion site pre-stent implantation was also evaluated by angiography. The prevalence of PP was 23.9% in Xience V versus 38.1% in Taxus Liberte (P = 0.025). The depth and angle of PP were greater in Taxus Liberte stent than Xience V stent (0.4 ± 0.1 mm versus 0.5 ± 0.2 mm, P = 0.004; and 32.0 ± 8.9° versus 44.6 ± 27.6°, P = 0.044, respectively). The angulation degree of the coronary artery at the lesion site was higher in presence of plaque prolapse than in its absence (48.2 ± 29.3° vs. 38.2 ± 28.1°, P = 0.013). By multivariate analysis, stent type was independently associated with incidence of plaque prolapse. Xience V stent has less plaque prolapse than Taxus Liberte stent. Stent design may play a role in the prevalence of plaque prolapse

Reducing Microvascular Dysfunction in Revascularized Patients with ST-Elevation Myocardial Infarction by Off-Target Properties of Ticagrelor versus Prasugrel. Rationale and Design of the REDUCE-MVI Study

Microvascular injury is present in a large proportion of patients with ST-elevation myocardial infarction (STEMI) despite successful revascularization. Ticagrelor potentially mitigates this process by exerting additional adenosine-mediated effects. This study aims to determine whether ticagrelor is associated with a better microvascular function compared to prasugrel as maintenance therapy after STEMI. A total of 110 patients presenting with STEMI and additional intermediate stenosis in another coronary artery will be studied after successful percutaneous coronary intervention (PCI) of the infarct-related artery. Patients will be randomized to treatment with ticagrelor or prasugrel for 1 year. FFR-guided PCI of the non-infarct-related artery will be performed at 1 month. Microvascular function will be assessed by measurement of the index of microcirculatory resistance (IMR) in the infarct-related artery and non-infarct-related artery, immediately after primary PCI and after 1 month. The REDUCE-MVI study will establish whether ticagrelor as a maintenance therapy may improve microvascular function in patients after revascularized STEMI

Impact of calcium on procedural and clinical outcomes in lesions treated with bioresorbable vascular scaffolds - A prospective BRS registry study

Background: There is limited data on the impact of calcium (Ca) on acute procedural and clinical outcomes in patients with lesions treated with bioresorbable vascular scaffolds (BRS). We sought to evaluate the effect of calcium on procedural and clinical outcomes in a 'real world' population. Methods: Clinical outcomes were compared between patients with at least 1 moderately or heavily calcified lesion (Ca) and patients with no/mild calcified lesions (non-Ca) enrolled in our institutional BRS registry. Results: 455 patients (N) with 548 lesions (L) treated with 735 BRS were studied. Patients in the Ca group (N = 160, L = 200) had more complex (AHA B2/C lesion: 69.0% in Ca vs 14.9% in non-Ca, p. <. 0.001) and significantly longer lesions (27.80. ±. 15.27 vs 19.48. ±. 9.92. mm, p. <. 0.001). Overall device success rate was 99.1% with no significant differences between the groups. Despite more aggressive lesion preparation and postdilation compared to non Ca, acute lumen gain was significantly less in Ca lesions (1.50. ±. 0.66 vs 1.62. ±. 0.69. mm, p = 0.040) with lower final MLD (2.28. ±. 0.41 vs 2.36. ±. 0.43, p = 0.046). There were no significant differences in all-cause mortality, total definite scaffold thrombosis (ST), target lesion revascularization and myocardial infarction between the 2 groups. Late ST was more frequent in the Ca group compared to non Ca group (late ST: 2.1 vs 0%, p = 0.02). Conclusions: Clinical outcomes after BRS implantation in calcified and non-calcified lesions were similar. A remarkable difference in timing of thrombosis was observed, with an increased rate of late thrombosis in calcified lesions