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

While the pasta cooks, heat olive oil in a large skillet over medium-high heat. Add the Italian sausage, breaking it up with a wooden spoon into small crumbles as it cooks. Brown the sausage for 6-8 minutes until fully cooked and nicely caramelized.

Add the minced garlic and red pepper flakes to the skillet with the sausage. Sauté for 1 minute until fragrant, being careful not to burn the garlic.

Pour in the crushed tomatoes and stir to combine. Season with salt and black pepper to taste. Reduce heat to medium-low and let the sauce simmer for 8-10 minutes, stirring occasionally, to allow the flavors to meld together.

Stir in the heavy cream and mix until the sauce becomes smooth and creamy. Let it simmer for another 2-3 minutes.

Add the cooked pasta to the skillet and toss everything together until the pasta is well coated with sauce. If the sauce seems too thick, add some reserved pasta water, a little at a time, until you reach your desired consistency.

Remove from heat and stir in half of the Parmesan cheese and the chopped fresh basil. Taste and adjust seasoning if needed.

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