A 68-year-old man with hypertension, dyslipidemia, and 20 pack-year smoking history presents with a 2-week history of transient monocular blindness in the left eye. Carotid duplex ultrasound is performed. The structure marked **B** in the diagram shows a hypoechoic, heterogeneous plaque with surface ulceration at the left carotid bifurcation, with peak systolic velocity of 185 cm/s. Which of the following best explains why this patient is at HIGH RISK for ipsilateral ischemic stroke despite moderate stenosis?
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