
Bring a large pot of salted water to a boil. Add pasta and cook according to package directions until al dente. Reserve 1 cup of pasta water before draining.
While pasta is cooking, remove sausage from casings and crumble into a large skillet over medium heat. Cook until browned, breaking it up with a spoon. Drain off any excess grease.
Add minced garlic to the skillet and cook for about 1 minute, until fragrant. Be careful not to burn the garlic.
Pour in heavy cream and bring to a simmer. Stir in grated Parmesan cheese until melted and smooth. Season with salt and pepper to taste.
Add cooked pasta to the skillet with the sauce. Toss to coat, adding reserved pasta water as needed to reach desired consistency.
Stir in fresh basil. Serve immediately, garnished with additional Parmesan cheese and fresh basil, if desired.
Serve hot and garnish with extra parmesan.