Objective. Coronary collateral circulation (CCC) mainly develops through arteriogenesis in response to shear forces. Increased arterial stiffness (AS) causes decreased coronary perfusion, which may reduce shear stress, arteriogenesis, and thus collateral formation. The aim of this study was to assess the relationship between CCC and AS in patients with chronic coronary total occlusion (CTO). Design. We prospectively enrolled 163 patients with CTO. Patients were divided into two groups according to their Rentrop scores: (a) poorly developed (PD) CCC group (Rentrop 0-1) and (b) well-developed (WD) CCC group (Rentrop 2-3). AS measurements were carried out using a Mobil-O-Graph arteriography system. Results. Fasting glucose, creatinine, uric acid, neutrophil count, and neutrophil-to-lymphocyte ratio were found to be higher in patients with PD-CCC. Moreover, patients with PD-CCC had significantly higher augmentation index (AIx) and pulse wave velocity (PWV) compared with WD-CCC group (27.3 +/- 8.9 vs. 18.7 +/- 7.4, p < 0.001 and 11.7 +/- 2.6 vs. 8.5 +/- 1.4, p < 0.001, respectively). In multivariate logistic regression analysis, PWV, AIx, and serum uric acid were found to be independently associated with the development of CCC. Conclusion. AS parameters, such as AIx and PWV, as well as serum uric acid are independently associated with the development of CCC in stable coronary artery disease with CTO.