We investigated the relationship between endocan (a marker of systemic inflammation) and the development of coronary collateral circulation (CCC) as evaluated by coronary angiography in patients with chronic stable angina pectoris. A total of 90 patients (32 poor CCC and 58 good CCC) were included in this study. Endocan levels were determined using a commercially available sandwich enzyme-linked immunosorbent assay kit with high sensitivity and specificity for detection of human endocan. In multivariate logistic regression analysis, low endocan levels were independently associated with good CCC (P < .001). Moreover, low high-sensitivity C-reactive protein levels were also independently associated with good CCC (P = .020). We found an optimal cutoff point for endocan of 1.7 ng/mL; it predicted the presence of good CCC with a sensitivity of 72.4% and specificity of 65.6% (P < .001). The results of the present study suggest that measurement of endocan level may help clinicians to predict the development of CCC in patients with stable coronary artery disease.