Proposed mechanism for the growth of the strong occlusive transverse cable. (A) Flowing aggregates of platelets and soluble VWF are captured on the collagen-coated glass slide forming rounded islets. ulVWF released by shear-activated platelets enhance growth of islets by catching more platelets. (B) Close islets are then linked by multiple, joined VWF fibers or ulVWF. We expect the maximum distance between 2 islets to be less than twice the length of ulVWFs (distance < 30 μm). (C) The transverse linkage between 2 islets forms a net that traps incoming platelets and VWF, aligning them with the linkage to form platelet-VWF strings. Islets located at the entrance of the stenosis merge transversally with one another and form the transverse cable infrastructure. (D) The transverse cable thickens likely by streamwise growth and streamwise merging. (E) The thicker transverse cable then physically arrests incoming WBCs.