You're confusing managed C++ with C++/CLI. The latter tries to introduce additional constructs to C++, so that it can partake in the CLR object model - and there you get all those limitations like no multiple inheritance. But you can, in fact, compile any random C++ code to IL - just run cl.exe with /clr:pure. The only thing that doesn't work in that case is setjmp/longjmp; everything else is available.
If you want to see it for yourself, take some .cpp file, and compile it with cl.exe /clr:pure /O2 /FAs. The latter switch will dump the IL assembly into the corresponding .asm file. Or you can inspect the output with ILSpy etc. You'll see that it compiles native C++ types down to CLR structs with no fields, but with explicitly set size (via StructLayout.Explicit); and then uses pointer arithmetic to access field values.
It was deprecated and will be removed eventually, but for now, it's still working fine.
Anyway, the point is that it's possible within CLR constraints. There's just not much demand for it, and it's effectively a whole separate CPU arch for the compiler to support, in addition to x86/x64/ARM.
If you want to see it for yourself, take some .cpp file, and compile it with cl.exe /clr:pure /O2 /FAs. The latter switch will dump the IL assembly into the corresponding .asm file. Or you can inspect the output with ILSpy etc. You'll see that it compiles native C++ types down to CLR structs with no fields, but with explicitly set size (via StructLayout.Explicit); and then uses pointer arithmetic to access field values.