Arkansas Children’s Heart Institute Successfully Implants Aortic Stent in Smallest Baby to Ever Receive It

Arkansas Children’s Heart Institute in Little Rock successfully implanted a specialized Renata Minima stent in the smallest baby in the world to ever receive it, in a premature infant weighing only 1.5 kilograms (3.3 pounds).   

Michael J. Angtuaco, M.D., FAAP, FSCAI, FPICS, an interventional pediatric cardiologist and medical director of the cardiac catheterization laboratory at Arkansas Children’s Hospital (ACH) and an associate professor of pediatrics in pediatric cardiology at the University of Arkansas for Medical Sciences, performed the procedure in the fall of 2024. This is the latest milestone for the institute’s innovative catheterization (cath) lab, which provides minimally invasive alternatives to open heart surgery.     

"This stent represents the kind of cutting-edge care we can provide at the Arkansas Children's Hospital Cath Lab," said Dr. Angtuaco. "We have the newest devices and technology, interventional techniques and imaging technology available nationwide. Anything that can be done in a cath lab, we can do in our cath lab, and our team has the knowledge and the skills to be able to do it."  

Why do some babies need stents?   

Coarctation of the aorta (CoA) is a common congenital heart defect, impacting about 2,200 babies in the United States each year, according to the Centers for Disease Control and Prevention. The aorta is the main artery that carries blood from the heart, and CoA means this artery is narrowed, restricting blood flow to the body. If left untreated, CoA can lead to heart failure or damage to other body organs.   

While ACH surgeons are skilled in surgical procedures to repair this, a non-surgical approach in the cath lab would offer a less invasive alternative for some patients. Many centers have offered balloon angioplasty for small infants, which widens the artery using a small balloon on a catheter. However, this technique carries a 20% risk of complications, including injury to the baby's blood vessels, Dr. Angtuaco said. To lower the risk of injury and provide a longer-lasting solution, intravascular stents are an option, reinforcing the narrowed blood vessel, but options have been limited for small patients.    

"For the smallest babies, we use the same stents that are used to treat coronary artery disease ('heart attacks') in adults," Dr. Angtuaco said. "The problem with these stents is they are only enlarged to about six millimeters, which will not be large enough for the aorta as the baby continues to grow. If we place a stent like this in a small baby, they will eventually need to have surgery to remove that stent. Ideally, we want this stent to stay in there forever and avoid surgery entirely."  

The Renata Minima is the only FDA-approved stent for treating infant vascular stenosis. The stents, designed to stretch to match the size of the blood vessel as the child grows, are initially as small as 5 mm when placed but can later be dilated to 24 mm - the size of an adult aorta.    

"The Renata Minima was approved by the FDA last year, and because my colleagues and I are active in attending national meetings, we were one of the first centers in the country to know it was available. We reached out to the company as soon as we heard there was an ACH patient who would be a good candidate for it," Dr. Angtuaco said.   

  

Groundbreaking stent procedure    

This first case at ACH using the Renata Minima stent was performed in the fall of 2024 when the baby was a month old. Dr. Angtuaco explained that, in the past, a premature baby needing surgery for this defect would stay in the neonatal intensive care unit (NICU) for months until they grew large enough for surgery. Due to the child’s size and other health complications, placing a Renata Minima stent in the institute’s state-of-the-art catheterization lab was the best option.  

"The Renata Minima stent was designed with our patients in mind. It's the best of both worlds," Dr. Angtuaco said. "The stent is designed to expand from the size that this premature infant needs all the way out to an adult size."   

The child's outcome from the procedure has been excellent, and he has continued to grow and develop without needing heart surgery. When he reached about seven kilograms (15 pounds), the team re-dilated his stent with another minimally invasive cath procedure, Dr. Angtuaco said. Dr. Angtuaco recently presented on this groundbreaking case at the Congenital and Structural Interventions (CSI) conference in Frankfurt, Germany, in June 2025. The case was a finalist for the conference's Best Cases and Abstracts Session award, which selects the most innovative cases worldwide.   

"Arkansas Children's Hospital offers the best care to patients. I'm proud to be able to offer world-class care to the children of Arkansas," Dr. Angtuaco said.   

  

This article was written by the Arkansas Children’s content team and medically reviewed by Michael J. Angtuaco, M.D. 

Photo: Michael J. Angtuaco, M.D., holds a 3D model of an infant heart.