Blunt carotid injury (BCI) is an uncommon disorder, occurring in trauma patients as a result of cervical hyperextension, hyperflexion, or direct blow. BCI is commonly present in initially asymptomatic patients who subsequently develop devastating thromboembolic complications of their injury. Although clinical predictors of injury have been developed, they are of limited accuracy. Nevertheless, employment of clinical screening criteria is of value in identifying at-risk patients in need of diagnostic testing. Liberalized screening of these trauma patients with angiography or the latest generation (64-multidetector) CT angiography facilitates early diagnosis and provides opportunity for timely intervention in asymptomatic victims. Anticoagulation and/or antithrombotic therapy in specific categories of these patients reduces neurologic morbidity and mortality. Endovascular stenting shows promise as a treatment modality for specific subsets of individuals with BCI. Surgery remains a therapeutic option for some surgically accessible lesions.