Illustration of a carotid artery with plaque ulceration emitting light, symbolizing stroke risk.

Unlocking Stroke Risk: Are You Overlooking This Key Factor?

Elliot Brynn in Health & Wellness August 2025 • 4 min read.

"New Study Reveals the Surprising Role of Plaque Ulceration and How It Impacts Your Health"

Atherosclerosis, the insidious buildup of plaque in our arteries, is a silent threat to our health. It begins subtly, with endothelial dysfunction leading to intimal thickening, eventually culminating in lipid accumulation and calcification. These plaques, especially the vulnerable ones, can rupture, triggering a cascade of events that lead to thrombus formation and, potentially, a devastating ischemic stroke.

For years, scientists have sought to unravel the intricate mechanisms underlying stroke risk. One area of intense investigation has been the role of von Willebrand Factor (VWF), a plasma glycoprotein crucial for platelet adhesion and thrombus formation. Elevated VWF levels have been linked to an increased risk of ischemic stroke, but the precise interplay between atherosclerotic plaque, hemostatic changes, and stroke remained unclear.

New imaging techniques like Computed Tomography Angiography (CTA) and Magnetic Resonance Imaging (MRI) enable to scrutinize plaque composition, identifying lipid-rich necrotic cores, intraplaque hemorrhage, and calcifications with remarkable precision. Also plaque ulceration, which is an independent predictor of ischemic stroke, can be detected with CTA and MRI as well.

The Plaque Ulceration Puzzle

Illustration of a carotid artery with plaque ulceration emitting light, symbolizing stroke risk.

In a recent study published in 'Thrombosis Research', researchers delved deeper into the relationship between plaque ulceration in the carotid artery and VWF levels. Plaque ulceration, characterized by the erosion of the plaque surface, is considered a critical step in the pathophysiology of ischemic stroke. The study aimed to determine whether a direct link exists between plaque ulceration and VWF levels in patients who have experienced a transient ischemic attack (TIA) or ischemic stroke.

The study involved 985 patients who underwent blood sampling, genotyping, and CTA of the carotid bifurcation. The researchers meticulously analyzed the data, looking for correlations between plaque ulceration, VWF levels, and other cardiovascular risk factors. Plaque ulceration was defined as an extension of contrast material greater than 1 mm in the surrounding atherosclerotic plaque on at least two orthogonal planes.

The distributions of VWF levels and calcification volumes in the carotid arteries were normalized by logarithmic transformation.
Linear regression analysis was used to analyze the relationship between ulceration, calcification volume and cardiovascular risk factors and VWF levels.
Model I was adjusted for age, sex and ABO blood group. Model II was additionally adjusted for calcification volume, and for cardiovascular risk factors with a p value < 0.05 in model I.

The results revealed a significant correlation between plaque ulceration and VWF levels after adjusting for age and sex. However, this association disappeared after further adjustment for blood group, calcification volume, and other cardiovascular risk factors. This suggests that the initial correlation may be influenced by confounding factors, rather than a direct causal relationship.

What This Means for You

While the study did not find a direct link between plaque ulceration and VWF levels, it underscores the complexity of stroke risk and the importance of addressing multiple risk factors. Managing cardiovascular health through lifestyle modifications, such as a healthy diet, regular exercise, and smoking cessation, remains crucial. Consulting with your healthcare provider to assess your individual risk factors and develop a personalized prevention plan is essential. By taking proactive steps, you can significantly reduce your risk of stroke and protect your brain health.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.thromres.2018.12.002, Alternate LINK

Title: No Independent Association Found Between Von Willebrand Factor And Plaque Ulceration In Carotid Artery Atherosclerosis

Subject: Hematology

Journal: Thrombosis Research

Publisher: Elsevier BV

Authors: Taihra Zadi, Michelle Sonneveld, Anouk C. Van Dijk, Burhan Hussain, Peter J. Koudstaal, Frank W.G. Leebeek, Moniek P.M. De Maat, A. Van Der Lugt

Published: 2019-02-01

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Everything You Need To Know

1

What is Atherosclerosis and how does it relate to stroke risk?

Atherosclerosis begins with endothelial dysfunction, leading to intimal thickening. This progresses to lipid accumulation and calcification, forming plaques. Vulnerable plaques can rupture, triggering thrombus formation, potentially leading to an ischemic stroke. Imaging techniques like Computed Tomography Angiography (CTA) and Magnetic Resonance Imaging (MRI) can identify components of plaque and also plaque ulceration. Understanding this process is crucial for stroke prevention.

2

What exactly is Plaque Ulceration and why is it considered important regarding stroke?

Plaque ulceration refers to the erosion of the plaque surface within the carotid artery. It's considered a critical step in the pathophysiology of ischemic stroke because it can trigger thrombus formation as blood interacts with the exposed plaque material. Detecting and understanding plaque ulceration is important for assessing stroke risk.

3

How was the study conducted to investigate the relationship between plaque ulceration and stroke?

The study published in 'Thrombosis Research' involved 985 patients who underwent blood sampling, genotyping, and Computed Tomography Angiography (CTA) of the carotid bifurcation. Researchers analyzed data to find correlations between plaque ulceration, von Willebrand Factor (VWF) levels, and other cardiovascular risk factors, using linear regression analysis adjusted for various factors to determine the relationship between these elements.

4

What did the 'Thrombosis Research' study reveal about the link between plaque ulceration and von Willebrand Factor (VWF) levels?

While the study initially found a correlation between plaque ulceration and von Willebrand Factor (VWF) levels, this association disappeared after adjusting for blood group, calcification volume, and other cardiovascular risk factors. This suggests that the initial correlation may be influenced by confounding factors rather than a direct causal relationship. This doesn't diminish the importance of VWF, as elevated levels are still associated with increased ischemic stroke risk, but it clarifies that the relationship with plaque ulceration may be more complex than initially thought.

5

What are the key takeaways from the study regarding stroke prevention, and what actions can individuals take to reduce their risk?

Although a direct causal link between plaque ulceration and von Willebrand Factor (VWF) levels wasn't confirmed in the study, managing cardiovascular health through lifestyle modifications remains crucial. Focus on a healthy diet, regular exercise, and smoking cessation. Consult with a healthcare provider to assess individual risk factors and develop a personalized prevention plan to reduce stroke risk and protect brain health. Future studies are needed to investigate other factors beyond VWF that might directly link to Plaque Ulceration.