Introduction: The recently proposed cerebral small vessel disease (CSVD) score system may help capture the overall burden of CSVD. This study aimed to investigate the associations between carotid artery ultrasound features and the burden score and cognitive performance of CSVD patients. Methods: This is a cross-sectional analysis of an ongoing prospective study. From May 2019 to October 2023, 287 patients with at least one neuroimaging marker of CSVD were recruited and underwent carotid ultrasound examination, brain magnetic resonance imaging (MRI) scans, and neuropsychological assessment. Carotid artery properties, including carotid plaque, intima-media thickness (IMT), beta stiffness index (beta-index), Peterson's elastic modulus (PEM), and pulse wave velocity-beta (PWV-beta), were calculated. The CSVD score was graded according to MRI evaluation. Participants were classified as having cognitive impairment (CI) or normal cognitive function (NCF) according to Montreal Cognitive Assessment (MoCA) scale. Results: A total of 209 eligible patients were included in the final analysis. A significant difference was revealed regarding the CSVD score between CI and NCF participants (p < 0.001). After adjusted for covariates, increased IMT (OR = 1.11, 95% CI: 1.04-1.37, p = 0.030) and PWV-beta (OR = 1.24, 95% CI: 1.09-1.51, p = 0.006) were both associated with the presence of CI. IMT and PWV-beta were also associated with worse performance on attention and processing speed (IMT: beta = -0.13, p = 0.011; PWV-beta: beta = -0.21, p = 0.011), and executive function (IMT: beta = -0.20, p = 0.024; PWV-beta: beta = -0.33, p = 0.008). Additionally, PEM was negatively associated with executive function (beta = -0.20, p = 0.009). Furthermore, binary logistic regression indicated that IMT (OR = 1.45, 95% CI: 1.18-2.01, p = 0.006), beta-index (OR = 1.30, 95% CI: 1.10-1.64, p = 0.008) and PWV-beta (OR = 1.23, 95% CI: 1.01-1.89, p = 0.047) were independently related to a moderate to severe CSVD burden score. Conclusions: Carotid artery atherosclerosis and stiffness are associated with the burden score and cognitive performance of CSVD patients. Noninvasive ultrasound parameters of the carotid artery are capable of discriminating high-risk individuals with CSVD.