Traumatic extracranial carotid and vertebral artery injuries often represent difficult clinical situations for doctors and surgeons staffed with the care of these patients. The complexity of these injuries often necessitates a multi-collaborative treatment approach with various specialties; additionally, these injuries can be resource intensive and often require immediacy of treatment. This chapter reviews the epidemiology, contemporary diagnosis and treatment algorithms, and management of blunt and penetrating cerebrovascular injuries with both operative and nonoperative managements discussed as well as the continued evolution of endovascular treatment modalities.