Objective To observe the effect of alteplase intra-arterial thrombolysis combined with continuous monitoring of transcranial Doppler (TCD) in patients with acute cerebral infarction. Methods Fifty-four patients with acute cerebral infarction were divided into TCD group and control group by random digits table method. The patients of 2 groups were given alteplase intra-arterial thrombolysis, and the patients of TCD groups were combined with continuous monitoring of TCD. The degree of clinical neurologic impairment was evaluated by National Institutes of Health stroke scale (NIHSS) and Barthel index (BI). The condition of vascular recanalization was evaluated by the change of blood flow signal of TCD. CT was performed within 1 d after thrombolysis to detect intracranial hemorrhage and other adverse reaction. The degree of clinical neurologic impairment, blood vessel recanalization rate after thrombolysis and recanalization time and incidence of intracranial hemorrhage and other adverse reaction were compared between 2 groups. Results There were no statistical difference in NIHSS score before thrombolysis and 1 h after thrombolysis between 2 groups (P>0.05). The NIHSS scores 7 and 30 d after thrombolysis in TCD group were significantly lower than those in control group:(8.1 ± 4.9) scores vs. (12.1 ± 4.2) scores and (6.9 ± 3.1) scores vs. (10.9 ± 3.9) scores, there were statistical differences (P<0.05). The BI scores 7 and 30 d after thrombolysis in TCD group were significantly higher than those in control group: (78.5 ± 13.8) scores vs. (60.8 ± 12.4) scores and (82.6 ± 13.5) scores vs. (63.2 ± 12.9) scores, and there were statistical differences (P<0.05). The blood vessel recanalization rate 24 h after thrombolysis in TCD group was significantly higher than that in control group: 70.4% (19/27) vs. 44.4% (12/27), the recanalization time after thrombolysis was significantly shorter than that in control group: (36.4 ± 9.5) min vs. (58.5 ± 12.4) min, and there were statistical differences (P<0.05). No adverse reaction like intracranial hemorrhage and so on was found by CT detection within 1 d after thrombolysis in the 2 groups. Conclusions Alteplase intra-arterial thrombolysis combined with continuous monitoring of TCD in acute cerebral infarction has good curative effect, and no obvious adverse reaction.