Cardiovascular disease is the number one cause of death worldwide, and thrombo-occlusive disease is a leading cause of morbidity and mortality. Ultrasound has been developed as a tool to induce the release, delivery, and enhanced efficacy of a thrombolytic drug (rt-PA) and bioactive gases from echogenic liposomes. By encapsulating drugs into micron-sized and nano-sized liposomes, the therapeutic can be shielded from degradation within the vasculature until delivery is triggered by ultrasound exposure. Insonification accelerates clot breakdown in combination with rt-PA and ultrasound contrast agents, which nucleate sustained bubble activity, or cavitation. Mechanisms for ultrasound enhancement of thrombolysis, with a special emphasis on cavitation and radiation force, will be reviewed. The delivery of bioactive gases from echogenic liposomes to promote vasodilation and cytoprotection will also be discussed.