Inclusion Criteria:  Diagnosed with chronic thromboembolic pulmonary hypertension according to current European society of cardiology/European Respiratory Society guidelines and eligible for both pulmonary endarterectomy and ballon pulmonary angioplasty by decision at the local multidisciplinary team conference and central adjudication committee Written informed consent from the patient Patient age >17 and <80 years Able to understand and follow instructions and to participate in the entire study period  Exclusion Criteria:  Life expectancy <12 months Co morbidities evaluated at the multidisciplinary team conference, that contributes significantly to the patients pulmonary hypertension Not possible to perform balloon pulmonary angioplasty or pulmonary endarterectomy within 4 months after randomization. Evaluated at multidisciplinary team conference that changes in pulmonary artery hypertension targeted therapy between baseline and 4 months follow-up is inevitable* Known pregnancy or positive urine Human chorionic gonadotropin screening test in fertile women Previous balloon pulmonary angioplasty or pulmonary endarterectomy