Well, Rust is closer to C++ than Lisp :)
If you look at the API https://blog.rust-lang.org/2018/12/21/Procedural-Macros-in-R...
it works on the level of raw tokens, not even the AST. So you have to construct your own AST via the parser if you want to manipulate AST.
Isn't viewing them as like external tools just a C centric view, based on C's (and C++'s) capabilities? Didn't Lisp have macros that manipulated the language as an AST prior to C even existing, inside the language?