Ultrasound-Guided Direct Thrombolytic Injection for Acute and Early-Subacute Arterial Occlusions: Feasibility and Early Outcomes

US-guided direct intrathrombus alteplase injection appears feasible with an acceptable safety profile and provides an early Doppler-defined response in selected patients. Prospective comparative studies are needed to define its role and refine patient selection.Clinical ImpactUltrasound-guided direct intrathrombus alteplase injection is a feasible, minimally invasive option for selected patients with acute and early-subacute arterial occlusions. The innovation is localized, real-time US-targeted delivery of low-dose tPA without catheter placement or prolonged infusion, combined with serial Doppler assessment to guide repeat dosing and timely escalation to angiography and adjunct endovascular therapy when indicated. For clinicians, this provides a practical workflow with close non-ICU monitoring, enabling early identification of residual thrombus, distal embolization, or underlying stenosis. The study also reinforces that shorter symptom duration strongly influences early recanalization.