In a large skillet or pot, heat olive oil over medium heat.
Add spicy sausage and cook, breaking it up with a spoon, until browned. Drain any excess fat.
Add chopped onion to the skillet and cook until softened, about 5-7 minutes.
Stir in minced garlic and cook for another minute until fragrant.
Pour in crushed tomatoes and bring the sauce to a simmer. Reduce heat to low, cover, and let it cook for at least 15-20 minutes, allowing flavors to meld.
While the sauce simmers, cook pasta according to package directions until al dente.
Stir heavy cream and grated Parmesan cheese into the sauce. Season with salt and black pepper to taste.
Add the cooked and drained pasta directly to the sauce and toss to combine.
Serve immediately, garnished with fresh chopped parsley.
