for execute the attack, the attacker needs to gain local administrative rights to the PC or server.

Once they get the access, they can modify the registry to force a reboot into Safe Mode.

They could then create attack tools that run in Safe Mode.

Hackers Can Use Windows Safe Mode To Steal PC Logins

Attackers can register a malicious COM object that is loaded by explorer.exe.

This enables that attackers code to run each time the explorer.exe needs to parse icons, CyberArk describes.

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source: www.techworm.net