Professor Rustam Al-Shahi Salman (MA MB BChir PhD FRCP Edin FHEA FESO)

Professor of clinical neurology

  • Centre for Clinical Brain Sciences
  • Edinburgh Clinical Trials Unit
  • Usher Institute of Population Health Sciences and Informatics

Contact details

Address

Street

Centre for Clinical Brain Sciences (CCBS)
Chancellor's Building
49 Little France Crescent

City
Edinburgh
Post code
EH16 4SB

Biography

Background

I lead the Research to Understand Stroke due to Haemorrhage (RUSH) programme, which is dedicated to improving the outcome for adults who have diseases that may cause, or have caused, intracranial hemorrhage.

I became interested in neurology during undergraduate medical training at Cambridge University. I was inspired to work on common neurological problems by Charles Warlow and the stroke research group in Edinburgh, which I joined in 1998 as an MRC clinical training fellow, progressing to MRC patient-oriented clinician scientist and senior clinical fellowships until 2016. Some of the fundamental study designs of observational clinical epidemiology have underpinned my initial focus on the frequency, prognosis, and pathophysiology of intracranial haemorrhage. Since becoming a professor of clinical neurology at the University of Edinburgh in August 2013, my research has increasingly focussed on methodologically rigorous randomised controlled trials of interventions to prevent and treat stroke due to intracranial haemorrhage. As an honorary consultant neurologist since 2006, I care for people with neurological conditions including stroke in-hours and out-of-hours, I audit their care, and I help undergraduate and postgraduate students to develop and address clinical uncertainties within the RUSH programme.

My lived experience of clinical research has made me concerned about increasing the value of biomedical research by minimising waste in the choice of research question, study design, study conduct, regulation, and reporting.  This led to me becoming one of the lead authors of The Lancet's 2014 Series on Increasing Value and Reducing Waste in Research (www.thelancet.com/series/research) and the related campaign (www.thelancet.com/campaigns/efficiency), as well as a founding member of the REWARD Alliance (http://rewardalliance.net).

However, the climate crisis is my greatest current concern. As president of the British & Irish Association of Stroke Physicians (www.BIASP.org), I led them to join the UK Health Alliance on Climate Change. I am a sustainability champion for the University of Edinburgh. I am working to reduce carbon consumption in stroke services in NHS Lothian with support from their carbon reinvestment fund. My default mode of transport is the bicycle.

Qualifications

2017 Fellow of the European Stroke Organisation (FESO)

2009 Fellow of the Higher Education Academy (FHEA)

2007 Fellow of the Royal College of Physicians of Edinburgh (FRCP Edin)

2006 Certificate of Completion of Specialist Training (CCST) in neurology, 31 October 2006

2005 PhD, University of Edinburgh

1997 MRCP (UK)

1993 MB BChir, University of Cambridge

1991 BA (Hons), University of Cambridge

Responsibilities & affiliations

2022 – MSc in Clinical Trials Steering Group, University of Edinburgh

2021 – Chair, Clinical Trials Oversight Group, University of Edinburgh

2021 – Sentinel Stroke National Audit Programme External Reference Group

2021 – Member, Scottish Stroke Subspecialty Training Committee (STC)

2021 – Member, Stroke Advisory Group, Association of British Neurologists

2020 – Clinical Director, Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh

2020 – Head of the Cerebrovascular Research Group, Centre for Clinical Brain Sciences, University of Edinburgh

2020 – President, British Association of Stroke Physicians

2020 – Chair, Brain Vascular Malformation Consortium (U54 NS065705) External Advisory Committee, part of the NIH Rare Diseases Clinical Research Network, USA

2020 – Member, BHF Data Science Centre Steering Group

2020 – Member, Sustainability Special Interest Group, Association of British Neurologists

2020 – Member, NHS Lothian COVID-19 Clinical Research Oversight Committee

2020 – Member, Intercollegiate stroke working party

2019 – Sustainability Champion, The University of Edinburgh

2019 – Member, Stroke Association Research Awards Pool

2018 – Board Member, Efficacy & Mechanism Evaluation funding committee, NIHR

2015 – Member, MRC Hubs for Trial Methodology Research, Recruitment Working Group

2015 – Patron, Cavernoma Alliance UK

2014 – Scientific and Medical Adviser, Cavernoma Alliance UK

2014 – present Edinburgh Clinical Academic Training Associate Director of this ‘run-through’ training for clinical academics from entry to (sub)specialty training to CCT (www.ecat.ed.ac.uk)2010 – Member, Edinburgh brain banks steering committee

2010 – present Edinburgh brain banks local management group and steering committee

2010 – present Lothian Audit of the Treatment of Cerebral Haemorrhage (LATCH) NHS Lothian audit project lead

2009 – Editor, Cochrane Stroke Group editorial board

2007 – Member, Scientific Advisory Board, Angioma Alliance, USA

1999 – present Scottish Audit of Intracranial Vascular Malformations (SAIVMs) NHS National Services Scotland national audit project lead

Undergraduate teaching

Clinical neurosciences module large group and bedside teaching

SSC5 research project supervision

Postgraduate teaching

Supervision of postgraduate clinical research fellows

2014 – present Edinburgh Clinical Academic Training Associate Director of this ‘run-through’ training for clinical academics from entry to (sub)specialty training to CCT (www.ecat.ed.ac.uk)

Open to PhD supervision enquiries?

Yes

Current PhD students supervised

PhD students

  • Caoimhe Kirby (August 2018 – July 2021)
  • Jamie Loan (August 2018 – July 2021)

Past PhD students supervised

PhD students

  • Marco Pasi, Lille, France (May 2018 – May 2021)
  • Kim Wiegertjes, Nijmegen, The Netherlands (September – December 2019)
  • Zien Zhou, Sydney, Australia (September 2018 – August 2021)
  • Tom Moullaali (January 2018 – December 2020)
  • Mark Rodrigues (January 2016 – December 2018)
  • Katie McGoohan (September 2014 – August 2018)
  • Candice Delcourt, Sydney, Australia (March 2014 – August 2017)
  • Kristiina Rannikmae (November 2010 – March 2016)
  • Margaret Horne (November 2010 – October 2013)
  • Neshika Samarasekera (February 2010 – January 2013)
  • Colin Josephson, Halifax, Canada (March 2009 – February 2011)
  • Janneke van Beijnum, Utrecht, The Netherlands (July – October 2007)
  • Charlotte Cordonnier, Lille, France (November 2005 – October 2006, ENS scholarship, Stevenson exchange scholarship)
  • Adam Kobayashi, Warsaw, Poland (March – April 2005, EFNS scholarship & January – March 2006, Polish-British Young Scientists Programme)

MSc students

  • Duncan Wilson, Operational Research
  • Tim Wilkinson, Translational Medicine
  • Joseph Frantzias, Neuroimaging
  • Marion Boulanger, Population Health Sciences

Research summary

I lead the Research to Understand Stroke due to Hemorrhage (RUSH) programme, which is dedicated to improving the outcome for adults who have diseases that may cause, or have caused, intracranial hemorrhage. The fundamental study designs of clinical epidemiology - such as randomised controlled trials, community- or population-based cohort and case-control studies, brain banking, and meta-analysis - are the foundation of my focus on the frequency, prognosis, treatment, and pathophysiology of intracranial haemorrhage. Since becoming a professor of clinical neurology at the University of Edinburgh in August 2013, the depth and breadth of my research has expanded beyond stroke and intracranial haemorrhage in response to several of the global challenges in non-communicable diseases, vascular multi-morbidity, cerebral small vessel diseases, and therapeutic dilemmas provoked by vascular ageing.

Current research interests

Randomised controlled trials: CARE: Cavernomas A Randomised Effectiveness pilot trial, to address the effectiveness of active treatment (with neurosurgery or stereotactic radiosurgery) versus conservative management in people with symptomatic brain cavernoma (ISRCTN41647111) ENRICH-AF: EdoxabaN foR IntraCranial Hemorrhage Survivors With Atrial Fibrillation (NCT03950076) TRIDENT: Triple therapy prevention of Recurrent Intracerebral Disease EveNts Trial (NCT02699645) DASH: Desmopressin for treatment of patients taking Antiplatelet agents with Stroke due to Haemorrhage (NCT03696121) SATURN: StATins Use in intRacerebral hemorrhage patieNts (NCT03936361) Treat_CCM: Propranolol in Cerebral Cavernous Malformation (NCT03589014) PROHIBIT ICH: Prevention Of Hypertensive Injury to the Brain by Intensive Treatment after IntraCerebral Haemorrhage: a pilot randomized trial of home telemetry-guided treatment (NCT03863665) Other research designs: Neuro-Inflammation after Cerebral Haemorrhage in Edinburgh (NICHE) 18F-Flutemetamol for the ante mortem recognition of intracerebral haemorrhage due to cerebral amyloid angiopathy Maximising a small vessel disease brain bank resource Pathomolecular mechanisms of intracerebral haemorrhage: functional analysis of collagen IV variants Long-term outcomes in unruptured brain arteriovenous malformation patients

Past research interests

SoSTART: Start or STop Anticoagulants Randomised Trial for atrial fibrillation after intracranial haemorrhage (NCT03153150) RESTART: REstart or STop Antithrombotics Randomised Trial after intracerebral haemorrhage (ISRCTN71907627) PATCH: platelet transfusion in cerebral haemorrhage (Netherlands National Trial Register NTR1303) ARUBA: a randomised trial of unruptured brain arteriovenous malformations (ISRCTN44013133) MASH-II: magnesium in aneurysmal subarachnoid haemorrhage (ISRCTN68742385) TICH-2: Tranexamic acid for hyperacute primary Intracerebral Haemorrhage ASCEND (A Study of Cardiovascular Events iN Diabetes) Cognitive Function Assessment: Evaluating the effect of aspirin, and omega-3 fatty acids, on cognitive function in diabetes CRASH-2 (Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage) IBS (Intracranial Bleeding Study) Does blood pressure variability (BPV) affect outcome after stroke due to intracerebral haemorrhage? Multi-modality imaging assessment of cerebral small vessel disease biomarkers after stroke due to spontaneous intracerebral haemorrhage What is the best brain imaging strategy for patients with suspected minor stroke or transient ischaemic attack (TIA)? Microbleeds and genetic risk factors to predict the risk of intracranial haemorrhage in patients treated with anticoagulation following cardioembolic stroke due to atrial fibrillation Role of 18F-Fluoride imaging as a novel marker of carotid plaque instability Validation and phenotyping of stroke outcomes in UK Biobank Transformation of the utility of secondary data in NHS Scotland by forging the “missing linkage” to imaging data The genetic factors predisposing to brain arteriovenous malformations

Knowledge exchange

Edinburgh International Science Festival

Pint of Science

Affiliated research centres

Project activity

I am focussed on the delivery of randomised controlled trials that directly inform the care of patients with intracranial haemorrhage (CARE, ENRICH-AF, TRIDENT, DASH, SATURN, Treat_CCM, and PROHIBIT ICH), alongside other research designs (NICHE, 18F-Flutemetamol MR-PET, and MARS).

Current project grants

2020-2023: NIHR Health Technology Assessment trial grant. Cavernomas A Randomised Effectiveness (CARE) pilot trial, to address the effectiveness of active treatment (with neurosurgery or stereotactic radiosurgery) versus conservative management in people with symptomatic brain cavernoma. Ref. NIHR128694 (£973,835)
2018-2023 The Stroke Association Haemorrhagic Stroke Priority Programme Award. NICHE: Neuro-Inflammation after Cerebral Haemorrhage in Edinburgh. Ref. TSA PPA 2017/01 (£449,482)
2016-2021 GE Healthcare Limited investigator sponsored study. 18F-Flutemetamol for the ante mortem recognition of intracerebral haemorrhage due to cerebral amyloid angiopathy (£51,000)

Past project grants

2018-2021 BHF clinical study grant. Start or STop Anticoagulants Randomised Trial (SoSTART) for atrial fibrillation after intracranial haemorrhage: safety phase. Ref. CS/18/2/33719 (£721,223)
2013-2021 British Heart Foundation Special Project Grant. REstart or STop Antiplatelets Randomised Trial. Ref. SP/12/2/29422 (£1,427,498)
2018-2020 BHF clinical research training fellowship (Thomas Moullaali). Does blood pressure variability (BPV) affect outcome after stroke due to intracerebral haemorrhage? Ref. FS/17/53/33119 (£168,553)
2016-2018 Wellcome Trust Edinburgh Clinical Academic Track clinical research training fellowship (Mark Rodrigues). Multi-modality imaging assessment of cerebral small vessel disease biomarkers after stroke due to spontaneous intracerebral haemorrhage. Ref. 203699/Z/16/Z (£223,001)
2016-2018 Chest Heart and Stroke Scotland Project Grant. REstart or STop Antithrombotics Randomised Trial for oral anticoagulants (RESTART-OAC). Ref. Res16/A166 (£89,909)
2015-2017 Academy of Medical Sciences INSPIRE award. The intercalated degree: in a nutshell (£4,950)
2014-2015 MRC Confidence in Concept scheme. Transformation of the utility of secondary data in NHS Scotland by forging the “missing linkage” to imaging data. Ref. MRC/CIC2/015 (£81,011)
2014-2017 British Heart Foundation project grant. PRIME-RESTART: Promoting Recruitment using Information Management Efficiently (PRIME) for randomised controlled trials of secondary prevention after stroke, piloted using the REstart or STop Antithrombotics Randomised Trial (RESTART). Ref. PG/14/50/30891 (£127,321)
2014-2017 Stroke Association postgraduate fellowship (Katie McGoohan). The importance of the consequences of ICH to patients and their carers (including nurses). Ref. TSA Postgrad 2014/02 (£105,000)
2013-2014 British Heart Foundation travel fellowship. Globalising the BHF REstart or STop Antithrombotics Randomised Trial (RESTART). Ref. FS/13/72/30531 (£21,850)
2013-2015 Academy of Medical Sciences INSPIRE award. INvolve Students with Undertaking Research in Edinburgh (INSURE) (£9,250)
2011-2016 MRC senior clinical fellowship. Cerebral amyloid angiopathy and intracerebral haemorrhage: community-based cohort study, biobank, and record linkage. Ref. G1002605 (£1,684,316)
2010-2013 MRC/Stroke Association clinical research training fellowship (Neshika Samarasekera). The contribution of amyloid angiopathy to intracerebral haemorrhage: a clinico-radio-pathological case-control study. Ref. G0900428 (£202,356)
2010-2016 Chest Heart and Stroke Scotland Project Grant. PATCH (Platelet Transfusion in Cerebral Haemorrhage). Ref. Res10 (£86,985)
2006-2007 Chief Scientist Office, Scottish Executive, Health Services Research Committee. A digital archive and web-based reviewing system for the imaging of
intracranial vascular malformations: a tool to measure observer variation. Ref. CZG/2/265 (£33,170)
2005-2010 MRC clinician scientist fellowship. Prognosis and management of intracranial vascular malformations and non-traumatic intracerebral haemorrhage in adults. Ref. G108/613 (£909,172)
2002 BUPA Foundation Epidemiology Award (£5,000)
2001-2004 The Stroke Association, Project Grant. A unique, prospective, population-based inception cohort in Scotland to establish the prognosis for intracranial vascular malformations (IVMs). Ref. TSA04/01 (£100,000)
2001-2004 Chief Scientist Office, Scottish Executive, BTRC Project Grant. Scottish Intracranial Vascular Malformation Study (SIVMS). Ref. CZB/4/35 (£107,347)
1998-2001 MRC clinical training fellowship. Prospective, population-based study of intracranial vascular malformations in Scotland Ref. G84/5176 (£109,910)
1998-2001 Chief Scientist Office, Scottish Executive, BTRC Project Grant. Scottish Intracranial Vascular Malformation Study (SIVMS). Ref. K/MRS/50/C2704 (£48,698)

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