NHC-catalyzed enantioselective [3 + 3] spiro-annulation of alpha,beta-unsaturated aldehydes with cyclic beta-ketoamides allowing the preparation of synthetically and biologically important spiro-glutarimide derivatives has been reported. The interception of the ketoamides with catalytically generated chiral alpha,beta-unsaturated acylazoliums proceeds in a Michael addition-intramolecular amidation pathway to deliver the spirocyclic products with good yield, diastereoselectivity, and enantioselectivity.