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