Former world team time trial champions BMC navigated their way around the flat but twisting 21.5-kilometre course in Lido Di Camaiore with a time of 22 minutes and 19 seconds to claim the victory.
The US-registered team finished with four riders Caruso, Rohan Dennis, Patrick Bevin and Greg Van Avermaet, with Caruso finishing first to earn the leader’s jersey.
Australian team Mitchelton-Scott placed second at four seconds, with Team Sky in third at nine seconds.
Mitchelton-Scott’s team included British general classification hope Adam Yates, who is now the highest ranked among the big overall contenders.
Geraint Thomas and Chris Froome finished with Sky’s leaders to position themselves favourably overall.
Current TTT world champions Team Sunweb finished in fifth spot, some 25 seconds adrift of BMC – not a perfect start for the team’s Tom Dumoulin, who is reportedly suffering from a cold.
Surprisingly out of the top 10 were Bahrain-Merida and Movistar, whose respective GC riders Vincenzo Nibali and Mikel Landa are now left with some work to do after the first day of the race.
Mark Cavendish’s race was thrown in doubt after he crashed during Dimension Data’s effort, rolling across the line on his own on a road bike and sporting an array of scuffs and road rash. He finished outside the time cut and is now out of the race.
It was the Manx sprinter’s first race back after withdrawing from the opening stage of the Abu Dhabi Tour due to concussion.
The 2018 edition of Tirreno-Adriatico continues on Thursday with stage two: a 167km trip from Camaiore to Follonica that offers a flat course that should favour a bunch sprint finish.
The WorldTour-level race concludes on Tuesday, March 13, with an individual time trial.
Tirreno-Adriatico 2018, stage one: Lido Di Camaiore to Lido Di Camaiore, 21.5km
1. BMC Racing, in 22-19
2. Mitchelton-Scott, at 4 secs
3. Team Sky, at 9 secs
4. Quick-Step Floors, at 15 secs
5. Team Sunweb, at 25 secs
6. Katusha-Alpecin, at 28 secs
7. Bora-Hansgrohe, at 30 secs
8. Trek-Segafredo, at 39 secs
9. UAE Team Emirates, at 45 secs
10. EF Education First-Drapac, at 45 secs
General classification after stage one
1. Damiano Caruso (Ita) BMC Racing, in 22-19
2. Rohan Dennis (Aus) BMC Racing, at same time
3. Patrick Bevin (NZl) BMC Racing, at same time
4. Greg Van Avermaet (Bel) BMC Racing, at same time
5. Luke Durbridge (Aus) Mitchelton-Scott, at 4 secs
6. Daryl Impey (RSA) Mitchelton-Scott, at 4 secs
7. Adam Yates (GBr) Mitchelton-Scott, at 4 secs
8. Michael Hepburn (Aus) Mitchelton-Scott, at 4 secs
9. Geraint Thomas (GBr) Team Sky, at 9 secs
10. Jonathan Castroviejo (Esp) Team Sky, at 9 secs