Purpose: Blunt cerebrovascular injury (BCVI) is a potentially devastating complication of trauma that is detected by CT angiography (CTA), guided by the Denver criteria. Acute assessment and management are well defined. Longer-term follow-up practices remain inconsistent. This study examines decade-long trends in BCVI screening, incidence, management, and follow-up at a State Trauma Unit. Methods: A retrospective cohort study was performed using the Royal Perth Hospital State Trauma Unit registry. All adults ≥18 years admitted with major trauma between 1 January 2015 and 31 December 2024 were included. Patients who had CTA for suspected BCVI were identified. Demographics, CTA indication, BCVI grade, acute management, and follow-up were extracted. Incidence was reported per major trauma admission and per CTA performed. Outcomes included hospital mortality, length of stay, and discharge destination. Analyses were descriptive and univariate, with odds ratios and confidence intervals reported. Ethics approval was obtained. Results: There were 9,724 major trauma admissions, increasing from 920 in 2015 to 1,123 in 2024. The median age was 49 years (IQR=35) with male predominance (74.7%). Use of CTA increased from 18% of admissions in 2015 to 37% in 2024. CTA was commonly indicated by radiologic findings (75.5%), with 5.0% indicated by clinical findings, and 19.5% by a combination. BCVI per CTA decreased from 20% in 2015 to 10% in 2024; BCVI per admission was static at 4.2%. BCVI associated with higher mortality (OR=2.1, 95%CI=1.6-2.8), longer length of stay by 7.5 days (95%CI=5.1-9.9), and greater need for rehabilitation (OR=2.6, 95%CI=2.1-3.3). Conclusion: BCVI incidence was consistent over a decade, despite a two-fold increase in CTA use. BCVI associated with higher mortality and morbidity, likely reflecting overall injury severity, not independent causation. Follow-up was variable, providing opportunity to standardise longer-term management pathways for BCVI patients.