Research - Prof Adrian Banning

Basic research

Professor Banning’s MD thesis (1993-95) involved the porcine model of carotid balloon angioplasty to study the pathophysiological response to arterial angioplasty injury. In collaboration with Professor N Crawford (Royal Free Hospital, London) he used a novel technique that employs platelets as a vehicle for drug delivery to the site of balloon injury. This study required the design and manufacture of a new double balloon, 4 lumen catheter. The studies demonstrated that locally applied iloprost-loaded platelets reduce platelet recruitment and intimal thickening following angioplasty.

In collaboration with Professor A Newby (Bristol) he investigated the role of matrix degrading metalloproteinase in neointima formation following angioplasty and studied the effect of angioplasty upon endothelial nitric oxide synthase (NOS) activity using NADPH diaphorase staining to co-localise NOS.

Based on the initial results, a collaborative study with Professor J Pollak (Hammersmith, London) was initiated, employing specific antibodies to iNOS and cNOS. Further collaboration with Professor H Drexler (Freiburg, Germany) to use polymerase chain reaction to semi-quantify mRNA expression of NOS following balloon injury. In collaboration with Dr J Giddings (Cardiff) changes in vessel wall von Willebrand factor immunoreactivity following balloon injury were studied.

Mechanisms of vascular injury following revascularisation

The work has focussed on translational research into mechanisms of injury in PCI. Initially Professor Banning and his team demonstrated the importance of Troponin elevation after PCI as it reflects new myocardial injury detected by MR imaging. Subsequent work investigated the mechanisms of these Troponin elevations and changes in blood flow in these newly injured areas.

Further investigations involved assessing the impact of opening chronic occlusions on myocardial function and meta-analysis on the long term prognostic implication of revascularisation injury have been carried out.

More recently, work has included a randomised controlled trial of PCI vs CABG with evidence of new myocardial injury as the endpoint (Eurointervention January 2011).

This work is likely to change the biochemical definitions of revascularisation injury within subsequent trials of revascularisation strategy.

With the opening of the new Acute Vascular Imaging Centre in Oxford, Professor Banning is now taking his work on coronary revascularisation to the acute setting (primary PCI for STEMI and NSTEMI), with ground breaking work on how impaired microvascular function might be predicted during the revascularisation procedure (Eurointervention July 2016).

Industry sponsored research

Professor Banning has been intimately involved with the initial clinical launch of drug eluting stents (DES) and he championed the use of intravascular ultrasound (IVUS) within the UK.

IVUS expertise was critical in being allowed to participate in landmark international interventional studies, such as TAXUS and Endeavour. These studies have complex entry requirements and require careful five year follow-up including 2 follow-up angiograms and intravascular ultrasound studies. Participation in these international clinical studies is subject to extremely intense scrutiny and external audit including review of individual angiograms, case records and outcomes. Professor Banning was the 2nd largest recruiter worldwide to TAXUS 2 (Circulation 2003).

Interview at EuroPCR 2016 featuring Adrian Banning talking about different approaches to optimise left main procedure outcome.

At the time of recruitment, the TAXUS 6 study was the most complex pattern of disease then studied. The Syntax trial was a landmark randomised study comparing drug eluting stents with coronary surgery in patients with complex coronary disease.

Professor Banning was the UK Principal Investigator (PI) for intervention and his centre became the 4th most successful recruitment centre in the world.

More recently he has recruited patients into the Resolution (Cordis), Platinum (Boston Sci) and Evolve (Boston Sci) trials. In October 2010 he randomised the first patient in the world into Excel, a 4000 patient trial of stents vs surgery for left main coronary disease (Abbott). Oxford was the 2^nd largest recruiter to this landmark trial.

Service development

In 1999, the Oxford-based team began day case treatment programmes for elective Percutaneous Coronary Intervention (PCI).

Subsequently they started day transfer for urgent cases with acute coronary syndromes. Both of these methods of service delivery were ground breaking and described in a peer review journal (Heart 2004). Transfer required a unique collaboration with St Johns Ambulance to arrange the return service.

In August 2007, launching region-wide Primary PCI required co-operation with Ambulance Trusts, colleagues from surrounding hospitals and multidisciplinary teams. This service has been successful in reducing hospital stay and probably improving outcomes.

Professor Banning’s service was the first in the UK to initiate paramedic delivery of clopidogrel in the community prior to hospital transfer. They became a reference site for the national NIAP project and the results were presented at the national launch of the report.

Professor Banning collaborated with Cardiac Surgeon Steve Westaby and was the co-principal investigator on the Jarvik Artificial Heart programme in Oxford. This is a left ventricular assist device (LVAD) designed for permanent implantation in patients not suitable for cardiac transplantation. They implanted the first device in a patient for destination therapy (Lancet) and then further implants in a number of patients. They ultimately had the longest surviving patient treated with this technology (New Engl J Med).

As Divisional Director for Cardiology, Cardiac Surgery, Thoracic Surgery and Vascular Surgery he lead the Division to create a robust Divisional Governance structure for patient care and financial independence. Under his leadership the Oxford Heart Centre was opened and he lead the Heartfelt Charitable appeal to raise £2 million to allow building of the purpose built Cardiology Outpatient Department

Professor Banning’s research

If you’d like to know more about Professor Banning’s research and his contribution to interventional cardiology, a list of his research papers and published books can be seen here.