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Bring a large pot of salted water to a rolling boil. Add the pasta and cook according to package directions until al dente. Reserve 1 cup of pasta cooking 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 and transfer the sausage to a plate, leaving a small amount of fat in the pan.
Reduce the heat to medium. Add the chopped onion to the skillet and cook until softened and translucent, about 5 minutes. Add the minced garlic and red pepper flakes (if using) and cook for another 1 minute until fragrant.

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

Stir in the heavy cream and grated Parmesan cheese until well combined. Return the cooked Italian sausage to the skillet. Add the drained pasta to the sauce and toss to coat.

If the sauce is too thick, add a splash or two of the reserved pasta cooking water until it reaches your desired consistency. Stir in the fresh basil.

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


Bring a large pot of salted water to a rolling boil. Add the pasta and cook according to package directions until al dente. Reserve 1 cup of pasta cooking 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 and transfer the sausage to a plate, leaving a small amount of fat in the pan.
Reduce the heat to medium. Add the chopped onion to the skillet and cook until softened and translucent, about 5 minutes. Add the minced garlic and red pepper flakes (if using) and cook for another 1 minute until fragrant.

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

Stir in the heavy cream and grated Parmesan cheese until well combined. Return the cooked Italian sausage to the skillet. Add the drained pasta to the sauce and toss to coat.

If the sauce is too thick, add a splash or two of the reserved pasta cooking water until it reaches your desired consistency. Stir in the fresh basil.

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