We recently described a pro-thrombolytic effect of ADAMTS13 on VWF-rich thrombi in mice.[19] Furthermore, low ADAMTS13 levels correlated with poor response to thrombolysis in stroke patients.[20] Second, insufficient ADAMTS13 activity or high VWF activity contributes to cerebral ischemia/reperfusion injury after successful recanalization.[4–6] Our observation that the VWF:ADAMTS13 ratio was the highest in patients with the most severe stroke further underscores this importance of the VWF/ADAMTS13 axis in stroke progression and is in line with other case-control studies.[10,11]. This evidence concerns the gene ADAMTS13 and brain ischemia.