The structural hierarchy of the occlusive mass consisted of a 200-μm-thick transverse cable made of parallel strings of PLTs linked by 1 to 0.05-μm-thin yarns made up of VWF. (A) Intermediate-magnification SEM showed that the transverse cable spanning the width of the stenosis was concave in shape. The thickness of the cable varied across the channel (40-200 μm). (B) High-magnification SEM (dashed square in panel A) revealed beads linked with one another like strings on beads (dashed line). These beads were identified as PLTs based on their diameter (1-2 μm) and appearance. The strings were parallel to each other and oriented perpendicular to the flow, similar to the cable. (C) A PLT linked by fibers. The thinnest fiber detected by SEM had a diameter of 0.05 μm. (D) A PLT linked by thicker yarns (0.5-1 μm). This PLT appeared to be degranulated, indicating that the yarns of VWF may have come from PLT α-granules. (E) Confocal microscopy 40-μm-high z-slice of a separate and representative (n = 3) high-shear thrombus labeled for VWF (green), fibrin (red), and DNA (blue). The transverse cable was rich in VWF and lacked fibrin, illustrating that the strings of PLTs were linked by yarns of VWF. (F) Directionality analysis of the transverse cable confirmed the transverse orientation of the PLT-VWF strings. (G) Schematic of the structural hierarchy of the occlusive transverse cable as being composed of strings of PLTs joined by yarns of VWF fibers. PLT, platelet.