Abstract-Cerebral, coronary, and peripheral artery diseases combined represent the most frequent cause of death in developed nations. The underlying progressive occlusion of large conductance arteries can partially be compensated for by transformation of preexisting collateral arterioles to small artery bypasses, a process referred to as arteriogenesis. Because biomechanical forces have been implicated in the initiation of arteriogenesis, we have investigated the mechanosensitive expression of a pivotal proarteriogenic molecule, monocyte chemoattractant protein (MCP)-1, which governs the recruitment of circulating monocytes to the wall of the remodeling collateral arterioles. Using a new ear artery ligation model and the classic hindlimb ischemia model in mice, we noted that MCP-1 expression is significantly increased in collateral arterioles undergoing arteriogenesis already 24 hours after its onset. By mimicking proarteriogenic perfusion conditions in small mouse arteries, we observed that MCP-1 expression is predominantly upregulated in the smooth muscle cells, which solely sense changes in circumferential wall tension or stretch. Subsequent analyses of cultured endothelial and smooth muscle cells confirmed that cyclic stretch but not shear stress upregulates MCP-1 expression in these cells. Blockade of the mechanosensitive transcription factor activator protein-1 by using a specific decoy oligodeoxynucleotide abolished this stretch-induced MCP-1 expression. Likewise, topical administration of the decoy oligodeoxynucleotide to the mouse ear abrogated arteriogenesis through downregulation of MCP-1 expression and monocyte recruitment. Collectively, these findings point toward a stretch-induced activator protein-1-mediated rise in MCP-1 expression in vascular smooth muscle cells as a critical determinant for the initiation of arteriogenesis. T he combination of atherosclerosis in cerebral, coronary, and peripheral arteries and its sequelae represent the single most important cause of death in the industrialized world. Thrombotic occlusion of these large conductance arteries often causes severe ischemia in the affected tissues. Based on the clinical relevance of the disease, significant efforts have been made to offset its consequences by stimulating the growth of new blood vessels into the ischemic area. 1 However, angiogenesis per se is not sufficient to fully restore blood supply to the affected tissues. 2,3 Spontaneous enlargement of collateral arterioles to small arteries bypassing the occluded main artery, an adaptive remodeling process referred to as arteriogenesis, on the other hand, seems to be much more efficient in compensating for the consequences of atherosclerosis. 4,5 Morphologically, collateral arteriolar enlargement is associated with a corkscrew-like appearance that is the consequence of a growth in length between 2 fixed points. 6 On the molecular level, arteriogenesis is characterized by the upregulation of adhesion molecules such as intercellular adhesion molecule (ICAM)-1 and chemokines like...