Coupling coordination is the core connotation of sustainable urban development. Few studies have considered the coupling coordination between low-carbon development and eco-environment (LC-EE) simultaneously for the key region, and ignored the interdependence of its influencing factors. Based on the coupling coordination degree model, this research analyzes the coordinated development level between LC-EE systems in prefecture-level cities of the Yellow River Basin (YRB). The qualitative comparative analysis method is employed to explore influencing factors configuration affecting the coupling coordination degree and further explore sustainable development pathways. The results indicate that the coupling coordination between LC-EE systems in the YRB has undergone considerable regional differences and achieved marginal balance, but several cities are fighting with imbalances. The configuration analysis shows that a single influencing factor does not constitute a necessary condition for the high coupling coordination degree. LC-EE coupling coordination is a multifactorial synergy, referring to the effective combination of technical, organizational, and environmental conditions which can promote sustainable development in the way of “all paths lead to the same goal”. Finally, based on the conclusion and the cities' realities, three kinds of sustainable development patterns are proposed, including the eco-industry promotion model, the government-led life service model, and the industry-city integration model.