Percutaneous coronary intervention (PCI) during ST-segment elevation myocardial infarction (STEMI) can be challenging due to limited distal vessel visualization. We present a case of challenging antegrade wiring during PCI of an inferior STEMI resulting in inadvertent subintimal wiring and ballooning. Recognition of this scenario prior to stenting allowed vessel rescue using the retrograde chronic total occlusion revascularization technique.