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Balloon-guide catheter (BGC) use during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) has been associated with improved procedural and clinical outcomes. However, the extent to which these benefits depend on operator experience remains unclear. We evaluated whether operator familiarity with BGCs influences technical efficacy when comparing BGCs with standard guide sheaths (GS) for MT.We retrospectively reviewed anterior circulation MT cases for large-vessel occlusion (LVO) performed between 2015 and 2025 at a comprehensive stroke center. Inclusion criteria were age >18 years and occlusion of the ICA terminus or M1/M2 segments. Patients with missing procedural or operator data were excluded. Neurointerventionalists were stratified by historical BGC utilization into low (Group A), medium (Group B), and high (Group C) use groups. The primary outcome was first-pass effect (FPE), defined as mTICI 2c-3 after a single pass. Secondary outcomes included puncture-to-first deployment time, puncture-to-reperfusion time, and 90-day modified Rankin Scale (mRS). Matched-pair analyses and mixed-effects models were performed.Among 2,290 included patients, 811 (35%) underwent BGC-assisted MT. Mean age was 72±15 years and 51% were female. Significant improvements in procedural times, FPE, and NIHSS change at discharge were observed only among high BGC-use operators (Group C). BGC use was associated with reduced puncture-to-first deployment and recanalization times and increased FPE rates, findings that persisted after adjustment for the operator group.The benefits of BGC-assisted MT are primarily realized by operators with consistent BGC experience, highlighting the importance of operator familiarity in achieving optimal outcomes.Disclosures G. Karayi: None. K. Moldovan: None. E. Shaaya: None.