Objective To study the effect of intravenous thrombolysis with edaravone and dexcamphenol combined with alteplase (rt-PA) on ultra-early acute cerebral infarction (ACI). Methods: 110 patients with ultra-early ACI in our hospital from January 2024 to January 2025 were selected as the research subjects. The research subjects were divided into the control group (n=55) and the observation group (n=55) by the random number table method. The control group was treated with rt-PA intravenous thrombolysis, and the observation group was treated with edaravone dexcamphor on the basis of the control group. The therapeutic effects, inflammatory factors [interleukin-6 (IL-6), C-reactive protein (CRP)], cerebral hemodynamic indicators [blood flow velocity of middle cerebral artery (MCA), posterior cerebral artery (PCA)], neurological functions [National Institutes of Health Stroke Scale (NIHSS)] and the incidence of adverse reactions of the two groups were analyzed and compared. Results The total effective rate of treatment in the observation group was significantly higher than that in the control group (P < 0.05). After treatment, the levels of deIL-6 and CRP in both groups were significantly lower than those before treatment, and the levels of IL-6 and CRP in the observation group after treatment were significantly lower than those in the control group (P < 0.05). After treatment, the blood flow velocities of MCA and PCA in both groups were significantly increased compared with those before treatment, and the blood flow velocities of MCA and PCA in the observation group after treatment were significantly higher than those in the control group (P < 0.05). After treatment, the NIHSS scores of both groups were significantly lower than those before treatment, and the NIHSS score of the observation group after treatment was significantly lower than that of the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion: Edaravone and dexcamphenol combined with rt-PA intravenous thrombolysis in the treatment of ultra-early ACI can improve the therapeutic effect, reduce inflammation, improve the blood flow velocity of the middle cerebral artery and posterior artery in patients, restore their neurological function, and has relatively high safety.