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Bring a large pot of salted water to a boil. Cook pasta according to package directions for al dente. Drain, reserving 1¼ cups cooking water. Return pasta to pot. Preheat broiler with rack in middle position.
Heat a large, broiler-safe skillet over medium-high. Add sausage; cook, breaking it up with a wooden spoon, until browned, 6 to 8 minutes. Transfer to pot with pasta.
Heat oil in skillet. Add Brussels sprouts and cook until wilted and charred, 3 to 4 minutes. Add flour and garlic; cook, stirring constantly, for 1 minute. Add ¼ cup cooking water and whisk until combined, about 30 seconds.
Reduce heat to medium. Stir in milk, Worcestershire sauce, and remaining 1 cup cooking water; bring to a simmer. Cook until liquid has reduced by a quarter, 6 to 7 minutes. Add 1¾ cups Gruyère. Stir in pasta and sausage.
Top pasta with Parmesan and remaining ¾ cup Gruyère. Broil until golden, 3 to 5 minutes.