Harrowing case from the National Hockey League yesterday. Richard Zednik catches a teammates' skate blade in the neck and severs his carotid artery. Amazingly, he skates off the ice, leaving a trail of blood, and the trainers are able to get a pressure dressing on the wound. Based on the wire reports it sounds like a primary repair was done and the guy is doing pretty well.
Interestingly, outcomes after penetrating carotid injuries are much better than those seen after blunt carotid trauma. Blunt injuries tend to be associated with extensive dissections, mural thrombi, and higher incidences of stroke. A nice clean transection (like from a skate blade) will often temporarily go into spasm or clot off, allowing for re-approximation in the OR once the ends are cleaned up. The key thing is whether the patient presents with neurologic deficits and/or coma. Some advocate simply ligating the carotid if this is the scenario, as repair will not affect the outcome.