Bring large pot of water to a boil. Salt generously and add in pasta and stir. Cook according to package directions for al dente and drain.
While pasta is cooking, remove sausage meat from casings and brown in a large cast iron skillet.
Remove meat from skillet to drain and set aside. Place cast iron skillet back on heat and add in butter. Cook 1-2 minutes to brown, then stir in garlic and cook until fragrant, 30 seconds.
Stir in heavy cream and cheese, then add in cooked sausage.
Taste and season with salt and pepper (if needed). Add pasta and toss to coat.
Top with chopped parsley and more parmesan cheese, if desired. Serve warm.