There have been few reports of mechanical thrombectomy (MT) for cerebral large vessel occlusion (LVO) of patients living on remote islands; the clinical practice in Japan is still unclear. We report treatment with drip, ship and retrieve (DSR) therapy of a 76-year-old man who developed a basilar artery occlusion on a remote island (Tsushima) in the Nagasaki Prefecture. This is the first achievement of DSR therapy on Tsushima Island. Using the isolated islands stroke hotline (I-SHOT) and a helicopter transportation system in collaboration with the mainland hub, the recanalization of the basilar artery occlusion was achieved 305 minutes from the onset. The patient recovered well and was discharged with no neurological deficits. It is difficult to provide specialized urgent care such as MT on remote islands. We have previously attempted DSR in six cases of LVO on Tsushima Island. However, these were all canceled due to long transportation times, sudden deterioration of the weather, or completion of the infarction. In recent years, the number of cases arriving at the mainland hub within six hours has increased because of the shortening of transportation times by I-SHOT. We present the first case of LVO on Tsushima Island successfully treated by DSR and report it based on previous LVO cases.