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Bring a large pot of generously salted water to a rolling boil. Add the pasta and cook according to package directions until al dente. Reserve 1 cup of pasta water before draining the pasta.

While the pasta is cooking, heat the olive oil in a large skillet or Dutch oven over medium-high heat. Add the Italian sausage, breaking it up with a spoon, and cook until browned and cooked through, about 5-7 minutes. Drain any excess fat.

Reduce the heat to medium. Add the diced yellow onion to the skillet with the sausage and cook until softened and translucent, about 4-5 minutes.

Stir in the minced garlic and red pepper flakes (if using) and cook for 1 minute until fragrant, being careful not to burn the garlic.

Pour in the crushed tomatoes, kosher salt, and black pepper. Bring the sauce to a simmer, then reduce the heat to low, cover, and let it cook for 10-15 minutes, allowing the flavors to meld.

Stir in the heavy cream and grated Parmesan cheese until well combined and the cheese has melted into the sauce.

Add the cooked and drained pasta to the skillet with the sauce. Toss to coat the pasta evenly. If the sauce is too thick, add a splash or two of the reserved pasta water until it reaches your desired consistency.

Stir in the chopped fresh basil. Taste and adjust seasoning as needed.

Serve immediately, garnished with additional fresh Parmesan cheese and basil, if desired.

Bring a large pot of generously salted water to a rolling boil. Add the pasta and cook according to package directions until al dente. Reserve 1 cup of pasta water before draining the pasta.

While the pasta is cooking, heat the olive oil in a large skillet or Dutch oven over medium-high heat. Add the Italian sausage, breaking it up with a spoon, and cook until browned and cooked through, about 5-7 minutes. Drain any excess fat.

Reduce the heat to medium. Add the diced yellow onion to the skillet with the sausage and cook until softened and translucent, about 4-5 minutes.

Stir in the minced garlic and red pepper flakes (if using) and cook for 1 minute until fragrant, being careful not to burn the garlic.

Pour in the crushed tomatoes, kosher salt, and black pepper. Bring the sauce to a simmer, then reduce the heat to low, cover, and let it cook for 10-15 minutes, allowing the flavors to meld.

Stir in the heavy cream and grated Parmesan cheese until well combined and the cheese has melted into the sauce.

Add the cooked and drained pasta to the skillet with the sauce. Toss to coat the pasta evenly. If the sauce is too thick, add a splash or two of the reserved pasta water until it reaches your desired consistency.

Stir in the chopped fresh basil. Taste and adjust seasoning as needed.

Serve immediately, garnished with additional fresh Parmesan cheese and basil, if desired.