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In this research, the sustainable applications for utilizing antimony tailing coarse aggregate (ATCA) in concrete is investigated. Comprehensive verifications were performed by a series of experiments on the characteristic of ATCA and the toxicity risks of concrete. Firstly, a real case study of utilization of ATCA as a complete substitute for natural coarse aggregate (NCA) in high strength concrete was conducted. Then, chemical composition of ATCA was tested. It is demonstrated that the essential mineral is SiO2 and the lithology of ATCA is quartzite. The mechanical properties, coarse quality of ATCA, and NCA were studied and compared. The compressive strength, splitting tensile strength, and compressive elastic modulus of ATWR are 221.51 MPa, 5.93 MPa, and 3.33 × 104 MPa, which are 1.31, 2.22, 1.40 times of that of NR, respectively. All of the quality control indices of ATCA meet the requirements of the current industry standards of China. Finally, the toxicity risks of ATCA concrete were investigated. It is illustrated that the leaching of main heavy metals including Sb, As, Hg, Pb, Cd, and Zn in the ATCA concrete under different pH conditions are below the regulatory limits. The utilization of antimony tailing has significant environmental and economic benefits. [ABSTRACT FROM AUTHOR]