Unmasking Culprit Complex Infero-Posterior STEMI: Navigating Ad Hoc RCA CTO PCI.

Patients presenting with acute coronary syndrome with ST-segment elevation myocardial infarction require rapid and decisive interventions to restore blood flow to the affected myocardium, minimizing ischemic damage. This case report is particularly unique because it involves a patient presenting with ST-segment elevation myocardial infarction, where the culprit lesion was an occluded coronary artery graft with an extensive thrombus burden. The complexity of this case necessitated a strategic shift to revascularize the chronically occluded native vessel instead of the graft. This highlights the intricate decision-making and advanced interventional techniques required in managing such complex clinical scenarios.