Background: While carotid pathologies are well-established risk factors for stroke, their specific effects on outcomes following stroke that cannot be classified as atherosclerotic remain unclear. In this study, we aimed to determine whether carotid pathologies are associated with functional dependence (FD) 3 months after small vessel occlusion (SVO) stroke. Methods: This retrospective study included patients with a first-ever SVO stroke admitted to a single cerebrovascular-specialty hospital between October 2021 and March 2024. Standardized ultrasound criteria were used to grade the carotid plaques. The modified Rankin scale (mRS) was used to assess functional outcomes at 3 months. Logistic regression analysis was performed to identify FD predictors (mRS of ≥2). Results: Of the 372 included patients, 276 achieved functional independence and 96 experienced FD at 3 months. Univariable analysis revealed an association between carotid plaque grade III and FD (odds ratio [OR], 2.46; 95% confidence interval [CI], 1.05–6.51; p = 0.049). However, this association was not significant in the multivariable model. Overall, age (adjusted OR, 1.07; 95% CI 1.03–1.10, p < 0.001), NIHSS at initial presentation (adjusted OR, 1.84; 95% CI, 1.55–2.18; p < 0.001), and diabetes (adjusted OR, 2.84; 95% CI, 1.37–5.92; p = 0.005) were independently associated with FD 3 months after SVO stroke. Conclusions: Carotid plaque severity was not independently associated with functional outcomes 3 months after SVO stroke. Age, NIHSS at initial presentation, and diabetes were identified as independent FD predictors. Future in-depth studies are warranted to confirm the complex interplay of factors influencing functional outcomes in patients with SVO stroke and carotid pathologies simultaneously.