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Heat a large skillet over medium-high heat and add the Italian sausage, breaking apart with a spatula until well-browned, about 5-7 minutes. Remove to a paper towel-lined plate.
Bring a large pot of salted water to a boil. Cook pasta according to package instructions. Be sure to save one cup of pasta water before you drain the pasta. I like to use a liquid measuring cup to scoop out one cup during the last minute of pasta cooking time.
In the same skillet you cooked the sausage, add the olive oil over medium heat. Add the minced shallot and garlic and sauté until softened and fragrant, about 4-5 minutes. Add the tomato paste, salt, pepper and red pepper flakes and stir. Deglaze the pan with the vodka, letting it sizzle out while scraping up the browned bits at the bottom of the skillet.
Stir in the cream, parmesan, and butter until well-combined. Add the pasta and sausage to the sauce and pour in reserved pasta water, starting with ½ cup and adding more as you need. I end up using the full cup, you want a glossy sauce that coats the pasta beautifully. If you don’t add enough pasta water, your pasta will be cakey and dry.
Garnish with fresh basil, more parmesan and fresh cracked pepper. Slay.